Disease-specific nutrition therapy: one size does not fit all
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REVIEW ARTICLE
Disease-specific nutrition therapy: one size does not fit all D. D. Yeh • G. C. Velmahos
Received: 24 October 2012 / Accepted: 4 February 2013 / Published online: 25 February 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Introduction The delivery of adequate nutrition is an integral part of the care of the critically ill surgical patient, and the provision of nutrition may have a greater impact on outcome than many other therapies commonly employed in the treatment of certain disease states. Methods A review of the existing literature was performed to summarize the evidence for utilizing diseasespecific nutrition in critically ill surgical patients. Results Enteral nutrition, unless specifically contraindicated, is always preferable to parenteral nutrition. Methodological heterogeneity and conflicting results plague research in immunonutrition, and routine use is not currently recommended in critically ill patients. Conclusion There is currently insufficient evidence to recommend the routine initial use of most disease-specific formulas, as most patients with the disease in question will tolerate standard enteral formulas. However, the clinician should closely monitor for signs of intolerance and utilize disease-specific formulas when appropriate. Keywords Nutrition Immunonutrition Renal failure Hepatic failure Obesity Pulmonary failure
D. D. Yeh (&) Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston 165 Cambridge St. #810, MA 02114, USA e-mail: [email protected] G. C. Velmahos Division Chief of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St. #810, Boston, MA, USA
Introduction The delivery of nutrition—previously an afterthought—has become recognized as an integral part of the care of the critically ill surgical patient. There are three main objectives: prevent infectious morbidity; preserve muscle mass; and prevent metabolic complications. In order to achieve optimal results, nutrition must be delivered at the appropriate time, by the appropriate route, in the appropriate dose, and in the appropriate ratio of specific components. This practice of targeted therapy has been aptly termed ‘‘nutritional pharmacology’’ [1, 2], and involves just as much care and deliberation as choosing antibiotics, vasopressors, or ventilator settings. Indeed, the provision of these pharmacologically active nutrients may have a greater impact on outcome than many other therapies commonly employed in the treatment of certain disease states. The benefits of providing timely nutrition are protean and extend far beyond the intensive care unit (ICU) and hospital stay as significant morbidity results from catabolism and global weakness. Yet, despite compelling evidence that there is a significant inverse correlation between the total daily calories received and the odds of mortality (Figs. 1, 2), ICUs worldwide deliver only ab
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