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Nutrition in Sepsis and Acute Surgical Patients

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Acute Care Surgery Handbook

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Abstract

Malnutrition is associated with increased morbidity and mortality. Septic patients and acute surgical patients are uniquely vulnerable to malnutrition due to underlying catabolism, high resting energy expenditure, and prolonged periods of starvation. Dedicated nutrition support teams that utilize dietitians and a systematic approach to nutrition therapy are fundamental to the care of the critically ill patient. Targeted nutrition therapy favorably impacts ultimate critical-care outcomes, such as nosocomial infections, duration of mechanical ventilation, length of stay, and mortality. However, available tools to evaluate “nutrition status” and to calculate calorie needs are limited, and innovations are needed. Early enteral nutrition (EN) is the preferred method for therapy in the intensive care unit (ICU), and confers several physiologic advantages, which include enhanced immunity, maintenance of intestinal function, and reduced inflammation. Parenteral nutrition (PN) is a second-line therapy due to associated morbidities, but can benefit select subgroups of patients. Optimal calorie targets, timing for delivery, feeding route, nutrition monitoring, and immunonutrition are ongoing controversies in the science of nutrition therapy.

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References

  1. McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009;33(3):277–316.

    Article  PubMed  Google Scholar 

  2. Binnekade JM, Tepaske R, Bruynzeel P. Daily enteral feeding practice on the ICU: attainment of goals and interfering factors. Crit Care (London, England). 2005;9(3):R218–25.

    Article  CAS  Google Scholar 

  3. Reid C. Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet Off J Br Diet Assoc. 2006;19(1):13–22.

    Article  CAS  Google Scholar 

  4. Giner M, Laviano A, Meguid MM, Gleason JR. In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. Nutrition. 1996;12(1):23–9.

    Article  CAS  PubMed  Google Scholar 

  5. Keel M, Trentz O. Pathophysiology of polytrauma. Injury. 2005;36(6):691–709.

    Article  PubMed  Google Scholar 

  6. Plank LD, Hill GL. Sequential metabolic changes following induction of systemic inflammatory response in patients with severe sepsis or major blunt trauma. World J Surg. 2000;24(6):630–8.

    Article  CAS  PubMed  Google Scholar 

  7. Heyland DK, Murch L, Cahill N, et al. Enhanced protein-energy provision via the enteral route feeding protocol in critically ill patients: results of a cluster randomized trial. Crit Care Med. 2013;41(12):2743–53.

    Article  CAS  PubMed  Google Scholar 

  8. Chung CK, Whitney R, Thompson CM, Pham TN, Maier RV, O’Keefe GE. Experience with an enteral-based nutritional support regimen in critically ill trauma patients. J Am Coll Surg. 2013;217(6):1108–17.

    Article  PubMed  Google Scholar 

  9. Parent B, Mandell S, Maier R, Minei J, Sperry J, Moore E, O’Keefe G. Safety of Minimizing Pre-operative Starvation in Critically-ill and Intubated Trauma Patients. J Trauma Acute Care Surg. 2016;80(6):957–63.

    Article  PubMed  Google Scholar 

  10. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159–211.

    Article  CAS  PubMed  Google Scholar 

  11. Huynh D, Chapman MJ, Nguyen NQ. Nutrition support in the critically ill. Curr Opin Gastroenterol. 2013;29(2):208–15.

    Article  CAS  PubMed  Google Scholar 

  12. Grune T, Berger MM. Markers of oxidative stress in ICU clinical settings: present and future. Curr Opin Clin Nutr Metab Care. 2007;10(6):712–7.

    Article  CAS  PubMed  Google Scholar 

  13. Motoyama T, Okamoto K, Kukita I, Hamaguchi M, Kinoshita Y, Ogawa H. Possible role of increased oxidant stress in multiple organ failure after systemic inflammatory response syndrome. Crit Care Med. 2003;31(4):1048–52.

    Article  CAS  PubMed  Google Scholar 

  14. Marik PE, Zaloga GP. Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ (Clinical research ed). 2004;328(7453):1407.

    Article  Google Scholar 

  15. McClave SA, Heyland DK. The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2009;24(3):305–15.

    Article  Google Scholar 

  16. Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK. Identifying critically-ill patients who will benefit most from nutritional therapy: Further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr (Edinburgh, Scotland). 2016;35(1):158–62.

    Article  Google Scholar 

  17. Doig GS, Simpson F, Finfer S, et al. Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial. JAMA. 2008;300(23):2731–41.

    Article  CAS  PubMed  Google Scholar 

  18. Jain MK, Heyland D, Dhaliwal R, et al. Dissemination of the Canadian clinical practice guidelines for nutrition support: results of a cluster randomized controlled trial. Crit Care Med. 2006;34(9):2362–9.

    Article  PubMed  Google Scholar 

  19. Parent B, Shelton M, Nordlund M, Aarabi S, O’Keefe G. Parenteral nutrition utilization after implementation of multidisciplinary nutrition support team oversight: a prospective cohort study. JPEN J Parenter Enteral Nutr. 2015.

    Google Scholar 

  20. Ferrie S, Allman-Farinelli M. Commonly used “nutrition” indicators do not predict outcome in the critically ill: a systematic review. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2013;28(4):463–84.

    Article  Google Scholar 

  21. Elke G, Felbinger TW, Heyland DK. Gastric residual volume in critically ill patients: a dead marker or still alive? Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2015;30(1):59–71.

    Article  Google Scholar 

  22. Reignier J, Mercier E, Le Gouge A, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA. 2013;309(3):249–56.

    Article  CAS  PubMed  Google Scholar 

  23. McClave SA, Lukan JK, Stefater JA, et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med. 2005;33(2):324–30.

    Article  PubMed  Google Scholar 

  24. Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest. 2006;129(4):960–7.

    Article  PubMed  Google Scholar 

  25. Rice TW, Mogan S, Hays MA, Bernard GR, Jensen GL, Wheeler AP. Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. Crit Care Med. 2011;39(5):967–74.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Arabi YM, Haddad SH, Tamim HM, et al. Near-target caloric intake in critically ill medical-surgical patients is associated with adverse outcomes. JPEN J Parenter Enteral Nutr. 2010;34(3):280–8.

    Article  PubMed  Google Scholar 

  27. Singer P, Anbar R, Cohen J, et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med. 2011;37(4):601–9.

    Article  PubMed  Google Scholar 

  28. Rhee P, Hadjizacharia P, Trankiem C, et al. What happened to total parenteral nutrition? The disappearance of its use in a trauma intensive care unit. J Trauma. 2007;63(6):1215–22.

    Article  PubMed  Google Scholar 

  29. Trujillo EB, Young LS, Chertow GM, et al. Metabolic and monetary costs of avoidable parenteral nutrition use. JPEN J Parenter Enteral Nutr. 1999;23(2):109–13.

    Article  CAS  PubMed  Google Scholar 

  30. Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506–17.

    Article  CAS  PubMed  Google Scholar 

  31. Dissanaike S, Shelton M, Warner K, O’Keefe GE. The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care (London, England). 2007;11(5):R114.

    Article  Google Scholar 

  32. Singer P, Pichard C. Reconciling divergent results of the latest parenteral nutrition studies in the ICU. Curr Opin Clin Nutr Metab Care. 2013;16(2):187–93.

    Article  CAS  PubMed  Google Scholar 

  33. Doig GS, Simpson F, Sweetman EA, et al. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. JAMA. 2013;309(20):2130–8.

    Article  CAS  PubMed  Google Scholar 

  34. Torgersen Z, Balters M. Perioperative nutrition. Surg Clin North Am. 2015;95(2):255–67.

    Article  PubMed  Google Scholar 

  35. Nathens AB, Neff MJ, Jurkovich GJ, et al. Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients. Ann Surg. 2002;236(6):814–22.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Drover JW, Dhaliwal R, Weitzel L, Wischmeyer PE, Ochoa JB, Heyland DK. Perioperative use of arginine-supplemented diets: a systematic review of the evidence. J Am Coll Surg. 2011;212(3):385–99, 399.e381.

    Article  PubMed  Google Scholar 

  37. Barker LA, Gray C, Wilson L, Thomson BN, Shedda S, Crowe TC. Preoperative immunonutrition and its effect on postoperative outcomes in well-nourished and malnourished gastrointestinal surgery patients: a randomised controlled trial. Eur J Clin Nutr. 2013;67(8):802–7.

    Article  CAS  PubMed  Google Scholar 

  38. Tan HB, Danilla S, Murray A, et al. Immunonutrition as an adjuvant therapy for burns. Cochrane Database Syst Rev. 2014;(12):CD007174.

    Google Scholar 

  39. Heyland D, Muscedere J, Wischmeyer PE, et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med. 2013;368(16):1489–97.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA, USA

    Brodie Parent MD & Ronald V. Maier MD, FACS, FRCS Ed (Hon)

Authors
  1. Brodie Parent MD
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  2. Ronald V. Maier MD, FACS, FRCS Ed (Hon)
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Correspondence to Brodie Parent MD .

Editor information

Editors and Affiliations

  1. Emergency and Trauma Surgery Service, C.A. Pizzardi Maggiore Hospital AUSL Bologna, Bologna, Italy

    Salomone Di Saverio

  2. Emergency and Trauma Surgery, Maggiore Hospital of Parma, Parma, Italy

    Fausto Catena

  3. General, Emergency and Trauma Surgery Papa Giovanni XXIII Hospital, Bergamo, Italy

    Luca Ansaloni

  4. General, Emergency and Trauma Surgery Papa Giovanni XXIII Hospital, Bergamo, Italy

    Federico Coccolini

  5. Trauma, Emergency Medicine Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA

    George Velmahos

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Parent, B., Maier, R.V. (2017). Nutrition in Sepsis and Acute Surgical Patients. In: Di Saverio, S., Catena, F., Ansaloni, L., Coccolini, F., Velmahos, G. (eds) Acute Care Surgery Handbook. Springer, Cham. https://doi.org/10.1007/978-3-319-15341-4_18

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  • DOI: https://doi.org/10.1007/978-3-319-15341-4_18

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15340-7

  • Online ISBN: 978-3-319-15341-4

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