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

  • Magdalini Kyriakopoulou
  • Stavrina Avgeropoulou
  • Anastasia Kotanidou
  • Foteini Economidou
  • Antonia Koutsoukou
Reference work entry

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.

Keywords

Zinc Obesity Fermentation Magnesium Lipase 

List of 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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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Magdalini Kyriakopoulou
    • 1
  • Stavrina Avgeropoulou
    • 1
  • Anastasia Kotanidou
    • 2
  • Foteini Economidou
    • 3
  • Antonia Koutsoukou
    • 1
  1. 1.ICU, 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of AthensSotiria HospitalAthensGreece
  2. 2.First Critical Care Department, Medical SchoolNational and Kapodistrian University of Athens, Evangelismos General HospitalAthensGreece
  3. 3.First Critical Care Department, Medical School, National and Kapodistrian University of Athens, Evangelismos General HospitalAthensGreece

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