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Obese Patients in Critical Care: Nutritional Support Through Enteral and Parenteral Routes

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Diet and Nutrition in Critical Care

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Abstract

As the obese population is globally increasing, it is nowadays quite common for these patients to be admitted in the intensive care unit. Management of obese patients in the critical care setting is challenging, as routine elements of nursing care, diagnostic and therapeutic interventions, as well as nutritional support can be quite complicated. Determination of energy requirements by means of predictive equations is not accurate, and indirect calorimetry – although few times available or feasible – remains the gold standard. Hypocaloric feeding with high protein provision is recommended for the nutritional support of the obese critically ill patient. This approach has demonstrated positive nutritional and clinical outcomes, avoiding the deleterious effects of overfeeding and minimizing lean body mass loss. Pharmaconutrition may be considered in the context of potential activity on the low-grade inflammatory state seen in obesity. Monitoring is the last integral part of the nutritional plan and is directed towards detection of complications (associated with obesity or improper feeding) and assessment of its therapeutic efficacy.

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Abbreviations

ABW:

Actual body weight

AjBW:

Adjusted body weight

ASPEN:

American society of parenteral and enteral nutrition

BMI:

Body mass index

BUN:

Blood urea nitrogen

EN:

Enteral nutrition

H:

Height

IBW:

Ideal body weight

IC:

Indirect calorimetry

ICU:

Intensive care unit

IL-1:

Interleukin-1

IL-10:

Interleukin-10

IL-6:

Interleukin-6

LBM:

Lean body mass

LBW:

Lean body weight

MCTs:

Medium-chained triglycerides

N2 :

Nitrogen

NAFLD:

Nonalcoholic fatty liver disease

NB:

Nitrogen balance

NPC:

Nonprotein calories

PN:

Parenteral nutrition

PUFAs:

Polyunsaturated fatty acids

REE:

Resting energy expenditure

SCCM:

Society of critical care medicine

TNF-a:

Tumor necrosis factor-a

TTR:

Transthyretin

UUN:

Urinary urea nitrogen

VCO2 :

Carbon dioxide production

VO2 :

Oxygen consumption

W:

Weight

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Authors and Affiliations

  1. ICU, 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria Hospital, 152 Mesogion Avenue, GR-11527, Athens, Greece

    Magdalini Kyriakopoulou, Stavrina Avgeropoulou & Antonia Koutsoukou

  2. First Critical Care Department, Medical School, National and Kapodistrian University of Athens, Evangelismos General Hospital, Athens, Greece

    Anastasia Kotanidou

  3. Leiden University Medical Center, Leiden, Netherlands

    Foteini Economidou

Authors
  1. Magdalini Kyriakopoulou
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  2. Stavrina Avgeropoulou
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  3. Anastasia Kotanidou
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  4. Foteini Economidou
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  5. Antonia Koutsoukou
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Corresponding author

Correspondence to Antonia Koutsoukou .

Editor information

Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Kyriakopoulou, M., Avgeropoulou, S., Kotanidou, A., Economidou, F., Koutsoukou, A. (2014). Obese Patients in Critical Care: Nutritional Support Through Enteral and Parenteral Routes. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_17-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_17-1

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  • Online ISBN: 978-1-4614-8503-2

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