Skip to main content
SpringerLink
Log in

Nutrition in the Critically Injured Patient

  • Chapter
  • First Online:
Trauma and Combat Critical Care in Clinical Practice

Part of the book series: In Clinical Practice ((ICP))

  • 981 Accesses

Abstract

Critically ill patients with severe traumatic injuries require precise attention to their nutrition in order to achieve rapid recovery and rehabilitation. Nutritional management can often be difficult in these patients and requires consideration of their baseline nutritional state as well as identification of the phase of critical illness. A key component of nutritional assessment is an accurate measure of the patient’s weight, either ideal or actual. In the absence of indirect calorimetry body weight is required to estimate energy requirements through use of predictive equations. In addition to energy, protein is an essential component of the nutritional provision, with protein requirements elevated following traumatic injury. A number of nutritional supplements, including glutamine, have been purported to improve outcome in critically ill trauma patients although evidence is conflicted. There has been much debate with regard the route of feeding in critically ill patients and studies have compared enteral and parenteral feeding; both routes appear safe but there seems to be no particular advantage in the early institution of parenteral feeding. A protocol-based approach to feeding ensures its early commencement and helps to achieve optimal nutritional goals. Finally, re-feeding syndrome is an important phenomenon in critically ill patients who present with a background of malnutrition.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 44.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 59.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. 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;12:23–9.

    Article  CAS  PubMed  Google Scholar 

  2. Alberda C, Gramlich L, Jones N, Jeejeebhoy K, Day AG, Dhaliwal R, Heyland DK. The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study. Intensive Care Med. 2009;35(10):1728–37.

    Article  PubMed  Google Scholar 

  3. Robinson MK, Mogensen KM, Casey JD, McKane CK, Moromizato T, Rawn JD, Christopher KB. The relationship among obesity, nutritional status, and mortality in the critically ill. Crit Care Med. 2015;43(1):87–100.

    Article  CAS  PubMed  Google Scholar 

  4. Faisy C, Lerolle N, Dachraoui F, Savard JF, et al. Impact of energy deficit calculated by a predictive method on outcome in medical patients requiring prolonged acute mechanical ventilation. Br J Nutr. 2009;101:1079–87.

    Article  CAS  PubMed  Google Scholar 

  5. Guidelines for the Provision of Intensive Care Services (GPICS). 2015. http://www.ficm.ac.uk/sites/default/files/GPICS%20-%20Ed.1%20%282015%29.pdf. Accessed 4 Oct 2015.

  6. Schetz M, Casaer MP, Van den Berghe G. Does artificial nutrition improve outcome of critical illness? Crit Care. 2013;17:302.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tremblay B. Impact of body mass index on outcomes following critical care. Chest. 2003;123(4):1202–7.

    Article  PubMed  Google Scholar 

  8. Preiser JC, et al. Metabolic and nutritional support of critically ill patients: consensus and controversies. Crit Care. 2015;19:35.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cuthbertson DP. The physiology of convalescence after injury. Br Med Bull. 1945;3:96–102.

    CAS  Google Scholar 

  11. Simpson F, Doig GS. Physical assessment and anthropometric measures for use in clinical research conducted in critically ill patient populations: an analytic observational study. J Parenter Enteral Nutr. 2013;39(3):313–21.

    Article  Google Scholar 

  12. The Malnutrition Universal Screening Tool. http://www.bapen.org.uk/screening-for-malnutrition/must/introducing-must. Accessed 4 Oct 2015.

  13. Berger MM, Pichard C. Best timing for energy provision during critical illness. Crit Care. 2012;16:215.

    PubMed  PubMed Central  Google Scholar 

  14. Lowell JA, Schifferdecker C, Driscoll DF, et al. Postoperative fluid overload: not a benign problem. Crit Care Med. 1990;18:728–33.

    Article  CAS  PubMed  Google Scholar 

  15. Adjusting body weight in amputees. http://www.amputee-life.org/2012/10/14/amputee-weight-loss/. Accessed 4 Oct 2015.

  16. NutritionDay. http://www.nutritionday.org/. Accessed 4 Oct 2015.

  17. Pichard C, Oshima T, Berger MM. Energy deficit is clinically relevant for critically ill patients: yes. Intensive Care Med. 2015;41(2):335–8.

    Article  PubMed  Google Scholar 

  18. Gandy J. Manual of dietetic practice. 5th ed. Chichester: Published by Wiley-Blackwell on behalf of the BDA; 2014.

    Google Scholar 

  19. Cerra F, Benitez M, Blackburn G, Irwin R, Jeejeebhoy K. Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. Chest. 1997;111:769–78.

    Article  CAS  PubMed  Google Scholar 

  20. Singer P, et al. ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr. 2009;28:387–400.

    Article  PubMed  Google Scholar 

  21. Henry CJ. Basal metabolic rate studies in humans: measurement and development of new equations. Public Health Nutr. 2005;8(7A):1133–52.

    Article  CAS  PubMed  Google Scholar 

  22. Frankenfield DC, Coleman A, Alam S, Cooney RN. Analysis of estimation methods for resting metabolic rate in critically ill adults. J Parenter Enteral Nutr. 2009;33:27–36.

    Article  Google Scholar 

  23. Frankenfield DC, Ashcraft CM. Estimating energy needs in nutrition support patients. J Parenter Enteral Nutr. 2011;35(5):563–70.

    Article  Google Scholar 

  24. Frankenfield DC. Validation of an equation for resting metabolic rate in older obese critically ill patients. J Parenter Enteral Nutr. 2011;35:264–9.

    Article  Google Scholar 

  25. Ireton-Jones CS, Turner WW, Liepa GU, Baxter CR. Equations for estimation of energy expenditure of patients with burns with special reference to ventilator status. J Burn Care Rehabil. 1992;13:330–3.

    Article  CAS  PubMed  Google Scholar 

  26. Faisy C, Guerot E, Diehl JL, Labrousse J, Fagon JY. Assessment of resting energy expenditure in mechanically ventilated patients. Am J Clin Nutr. 2003;78:241–9.

    CAS  PubMed  Google Scholar 

  27. Harris JA, Benedict FG. A biometric study of the basal metabolism in man. Washington, DC: Carnegie Institution of Washington; 1919. p. 279; Publication no. 279.

    Google Scholar 

  28. Genton L, Pichard C. Protein catabolism and requirements in severe illness. Int J Vitam Nutr Res. 2011;81:143–52.

    Article  CAS  PubMed  Google Scholar 

  29. Doig GS. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. JAMA. 2013;309:2130–8.

    Article  CAS  PubMed  Google Scholar 

  30. Larsson J, et al. Nitrogen requirements in severely injured patients. Br J Surg. 1990;77(4):413–6.

    Article  CAS  PubMed  Google Scholar 

  31. Shaw JH, et al. Whole body protein kinetics in severely septic patients. The response to glucose infusion and total parenteral nutrition. Ann Surg. 1987;205:288–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Ishibashi N, Plank LD, Sando K, Hill GL. Optimal protein requirements during the first 2 weeks after the onset of critical illness. Crit Care Med. 1998;26(9):1529–35.

    Article  CAS  PubMed  Google Scholar 

  33. Liebau F, Wernerman J, van Loon LJC, Rooyackers O. Effect of initiating enteral protein feeding on whole-body protein turnover in critically ill patients. Am J Clin Nutr. 2015;101:549–57.

    Article  CAS  PubMed  Google Scholar 

  34. Liebau F, Sundström M, van Loon LJV, Wernerman J, Rooyackers O. Short-term amino acid infusion improves protein balance in critically ill patients. Crit Care. 2015;19:106.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Casaer MP, Mesotten D, Hermans G, Wouters PJ. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365:506–17.

    Article  CAS  PubMed  Google Scholar 

  36. Puthucheary Z, Montgomery H, Moxham J, Harridge S, Hart N. Structure to function: muscle failure in critically ill patients. J Physiol. 2010;588:4641–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Singer P, Anbar R, Cohen J, Shapiro H. 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 

  38. Allingstrup MJ, Esmailzadeh N, Wilkens Knudsen A, Espersen K. Provision of protein and energy in relation to measured requirements in intensive care patients. Clin Nutr. 2012;31(4):462–8.

    Article  PubMed  Google Scholar 

  39. Rousseau AF, Losser MR, Ichai C, Berger MM. ESPEN endorsed recommendations: nutritional therapy in major burns. Clin Nutr. 2013;32:497–502.

    Article  PubMed  Google Scholar 

  40. Cano N, Fiaccadori E, Tesinsky P, Toigo G, Druml W. ESPEN guidelines on enteral nutrition: acute renal failure. Clin Nutr. 2006;25:295–310.

    Article  CAS  PubMed  Google Scholar 

  41. Choban P, et al. ASPEN clinical guidelines. Nutrition support of hospitalised adult patients with obesity. J Parenter Enteral Nutr. 2013;37:714–44.

    Article  Google Scholar 

  42. Streat SJ, Beddoe AH, Hill GL. Aggressive nutritional support does not prevent protein loss despite fat gain in septic intensive care patients. J Trauma. 1987;27:262–6.

    Article  CAS  PubMed  Google Scholar 

  43. Plank LD, Hill GL. Similarity of changes in body composition in intensive care patients following severe sepsis or major blunt injury. Ann N Y Acad Sci. 2000;9:592–602.

    Google Scholar 

  44. Monk DN, Plank LD, Franch-Arcas G, Finn PJ, Streat SJ, Hill GL. Sequential changes in the metabolic response in critically injured patients during the first 25 days after blunt trauma. Ann Surg. 1996;223:395–405.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288:2859–67.

    Article  PubMed  Google Scholar 

  46. Rafferty G, Moxham J. Assessment of peripheral and respiratory muscle strength in ICU. In: Stevens R, Hart N, Herridge M, editors. Textbook of post-ICU medicine: the legacy of critical care. Oxford: Oxford University Press; 2014.

    Google Scholar 

  47. Manzanares W, Langloisb PL, Hardy G. Update on antioxidant micronutrients in the critically ill. Curr Opin Clin Nutr Metab Care. 2013;16:719–25.

    Article  CAS  PubMed  Google Scholar 

  48. Manzanares W, Dhaliwal R, Jiang X, Murch L, Heyland DK. Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis β-blockers in critically ill patients: from physiology to clinical evidence. Crit Care. 2012;16:R66.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Reddell L, Cotton BA. Antioxidant and micronutrient supplementation in critically ill trauma patients. Curr Opin Clin Nutr Metab Care. 2012;15(2):181–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Andrews PJ, Avenell A, Noble DW, Campbell MK, Croal BL, Simpson WG, Vale LD, Battison CG, Jenkinson DJ, Cook JA, Scottish Intensive care Glutamine or seleNium Evaluative Trial Trials Group. Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients. BMJ. 2011;342:d1542.

    Article  PubMed  Google Scholar 

  51. Heyland D, Muscedere J, Wischmeyer PE, Cook D, Jones G, Albert M, Elke G, Berger MM, Day AG, Canadian Critical Care Trials Group. 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 

  52. Wernerman J. How to understand the results of studies of glutamine supplementation. Crit Care. 2015;19:385.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Coppola S, Froio S, Chiumello D. β-blockers in critically ill patients: from physiology to clinical evidence. Crit Care. 2015;19:119.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Gervasio JM, Dickerson RN, Swearingen J, Yates ME, Yuen C, Fabian TC, Croce MA, Brown RO. Oxandrolone in trauma patients. Pharmacotherapy. 2000;20(11):1328–34.

    Article  CAS  PubMed  Google Scholar 

  55. Kreymann KG, Berger MM, Deutz NE, Hiesmayr M. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr. 2006;25(2):210–23.

    Article  CAS  PubMed  Google Scholar 

  56. Clinical practice guideline for nutrition support in the mechanically ventilated, critically ill adult patient. www.criticalcarenutrition.com. Accessed 4 Oct 2015.

  57. McClave SA, 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.). J Parenter Enteral Nutr. 2009;33(3):277–316.

    Article  Google Scholar 

  58. Martin CM, Doig GS, Heyland DK, Morrison T, Sibbald WJ, Southwestern Ontario Critical Care Research Network. Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT). CMAJ. 2004;170:197–204.

    PubMed  PubMed Central  Google Scholar 

  59. Harvey SE, Parrott F, Harrison DA, Bear DE. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014;371(18):1673–84.

    Article  PubMed  Google Scholar 

  60. Heidegger CP, Berger MM, Graf S, Zingg W. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013;381(9864):385–93.

    Article  PubMed  Google Scholar 

  61. Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. J Parenter Enteral Nutr. 2003;27:355–73.

    Article  Google Scholar 

  62. Simpson D. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med. 2005;31(1):12–23.

    Article  PubMed  Google Scholar 

  63. Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition. 2004;20:843–8.

    Article  PubMed  Google Scholar 

  64. Compton F, et al. Use of a nutrition support protocol to increase enteral nutrition delivery in critically ill patients. Am J Crit Care. 2014;23(5):369–403.

    Article  Google Scholar 

  65. Mackenzie S, et al. Implementation of a nutrition support protocol increases the proportion of mechanically ventilated patients reaching enteral nutrition targets in the adult intensive care unit. J Parenter Enteral Nutr. 2005;29:74–80.

    Article  Google Scholar 

  66. Enhanced protein-energy provision via the enteral route feeding protocol in critically ill patients: The PEP uP protocol. http://www.criticalcarenutrition.com/docs/tools/NIBBLE_Issue8_Generic.pdf=refPepup. Accessed 4 Oct 2015.

  67. Taylor B, Brody R, Denmark R, Southard R, Byham-Gray L. Improving enteral delivery through the adoption of the “Feed Early Enteral Diet Adequately for Maximum Effect (FEED ME)” protocol in a surgical trauma ICU: a quality improvement review. Nutr Clin Pract. 2014;29(5):639–48.

    Article  PubMed  Google Scholar 

  68. Ott L, Young B, Phillips R, McClain C, Adams L, Dempsey R, Tibbs P, Ryo UY. Altered gastric emptying in the head-injured patient: relationship to feeding intolerance. J Neurosurg. 1991;74(5):738–42.

    Article  CAS  PubMed  Google Scholar 

  69. Hamada SR, Garcon P, Ronot M, Kerever S, Paugam-Burtz C, Mantz J. Ultrasound assessment of gastric volume in critically ill patients. Intensive Care Med. 2014;40:965–72.

    Article  CAS  PubMed  Google Scholar 

  70. McClave SA, Lukan JK, Stefater JA, Lowen CC. 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 

  71. Montejo JC, et al. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med. 2010;36(8):1386–93.

    Article  CAS  PubMed  Google Scholar 

  72. Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, Clavel M, Frat JP, Plantefeve G, Quenot JP, Lascarrou JB, Clinical Research in Intensive Care and Sepsis (CRICS) Group. 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 

  73. Nguyen NQ, Chapman MJ, Fraser RJ, Bryant LK, Holloway RH. Erythromycin is more effective than metoclopramide in the treatment of feed intolerance in critical illness. Crit Care Med. 2007;35:483–9.

    Article  CAS  PubMed  Google Scholar 

  74. Gert van der Meer Y, Venhuizen WA, Heyland DK, van Zanten ARH. Should we stop prescribing metoclopramide as a prokinetic drug in critically ill patients? Crit Care. 2014;18(5):502.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Niv E, Fireman Z, Vaisman N. Post-pyloric feeding. World J Gastroenterol. 2009;15:1281–8.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Zhang Z, Xu X, Ding J, Ni H. Comparison of postpyloric tube feeding and gastric tube feeding in intensive care unit patients: a meta-analysis. Nutr Clin Pract. 2013;28:371–80.

    Article  PubMed  Google Scholar 

  77. Sertaridou E, Papaioannou V, Kolios G, Pneumatikosa I. Gut failure in critical care: old school versus new school. Ann Gastroenterol. 2015;28:309–22.

    PubMed  PubMed Central  Google Scholar 

  78. Vanderheyden S, et al. Early versus late parenteral nutrition in ICU patients: cost analysis of the EPaNIC trial. Crit Care. 2012;16:R96.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Grimble R. Fatty acid profile of modern lipid emulsions: scientific considerations for creating the ideal composition. Clin Nutr Suppl. 2005;1:9–15.

    Article  CAS  Google Scholar 

  80. NCEPOD: parenteral nutrition: a mixed bag. http://www.ncepod.org.uk/2010pn.html, http://www.ncepod.org.uk/2010report1/downloads/PN_report.pdf.

  81. International Nutrition Survey. http://www.criticalcarenutrition.com/index.php?option=com_content&view=article&id=146&Itemid=50. Accessed 4 Oct 2015.

  82. Oudemans-van Straaten HM, Ostermann M. Bench-to-bedside review: citrate for continuous renal replacement therapy, from science to practice. Crit Care. 2012;16:249. DOI: 10.1186/cc11645. © BioMed Central Ltd 2012. Published 7 December 2012.

    Google Scholar 

  83. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008;336:1495–8.

    Google Scholar 

  84. Goyale A, Ashley SL, Taylor DR, Elnenaei MO, et al. Predicting refeeding hypophosphataemia: insulin growth factor 1 (IGF-1) as a diagnostic biochemical marker for clinical practice. Ann Clin Biochem. 2015;52:82–7.

    Article  CAS  PubMed  Google Scholar 

  85. NICE clinical guideline 32. 2006. http://www.nice.org.uk/guidance/cg32/resources/guidance-nutrition-support-in-adults-pdf. Accessed 4 Oct 2015.

Download references

Author information

Authors and Affiliations

  1. Critical Care Department, King’s College Hospital NHS Trust, Denmark Hill, London, SE5 9RS, UK

    Stephanie R. Strachan MBBS, MMedEd, MRCP, FRCA, DICM

  2. Nutrition and Dietetics Department, King’s College Hospital NHS Trust, Denmark Hill, London, SE5 9RS, UK

    Karen Friend BSc, PgDip

Authors
  1. Stephanie R. Strachan MBBS, MMedEd, MRCP, FRCA, DICM
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karen Friend BSc, PgDip
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephanie R. Strachan MBBS, MMedEd, MRCP, FRCA, DICM .

Editor information

Editors and Affiliations

  1. Royal Navy and King's College Hospital, London, United Kingdom

    Sam D. Hutchings

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Crown Copyright

About this chapter

Cite this chapter

Strachan, S.R., Friend, K. (2016). Nutrition in the Critically Injured Patient. In: Hutchings, S. (eds) Trauma and Combat Critical Care in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-28758-4_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-28758-4_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-28756-0

  • Online ISBN: 978-3-319-28758-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation