Metabolic Support of the Obese Intensive Care Unit Patient
As the prevalence of obesity has increased, the number of obese patients admitted to ICUs has also increased. Nutritional assessment and support is a key element in the proper management of critically ill obese patients. Estimating caloric requirements of critically ill obese patients with predictive equations is challenging, as most of these equations were developed for the nonobese population. Currently, indirect calorimetry remains the gold standard for estimating energy requirements. Hypocaloric feeding is recommended for most critically ill obese patients. It is intended to reduce nonprotein calorie infusions while maximizing protein sparing. The caloric goal should not exceed 60–70 % of energy requirements, with a daily intake of at least 2.0–2.5 g/kg ideal body weight of protein required. This hypocaloric feeding regimen will prevent complications of overfeeding, such as hyperglycemia and fluid retention, while preserving lean body mass and promoting steady controlled weight loss. Further investigations are needed for clinical use of pharmaconutrients in critically ill obese patients, though some experimental studies have shown positive results. Those listed above may be considered in the nutritional treatment of critically ill obese patients.
KeywordsObesity Critical illness Nutrition support Hypocaloric feeding
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