Nutrition therapy for critically ill and injured patients
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REVIEW ARTICLE
Nutrition therapy for critically ill and injured patients I. Afifi • S. Elazzazy • Y. Abdulrahman R. Latifi
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Received: 24 October 2012 / Accepted: 19 February 2013 / Published online: 8 March 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Background Nutrition support has undergone significant advances in recent decades, revolutionizing the care of critically ill and injured patients. However, providing adequate and optimal nutrition therapy for such patients is very challenging: it requires careful attention and an understanding of the biology of the individual patient’s disease or injury process, including insight into the consequent changes in nutrients needed. Objective The objective of this article is to review the current principles and practices of providing nutrition therapy for critically ill and injured patients. Methods Review of the literature and evidence-based guidelines. Results The evidence demonstrates the need to understand the biology of nutrition therapy for critically ill and injured patients, tailored to their individual disease or injury, age, and comorbidities. Conclusion Nutrition therapy for critically ill and injured patients has become an important part of their overall care. No longer should we consider nutrition for critically ill and injured patients just as ‘‘support’’ but, rather, as ‘‘therapy’’, because it is, indeed, a key therapeutic modality.
I. Afifi Y. Abdulrahman R. Latifi Trauma Section, Hamad General Hospital, Doha, Qatar S. Elazzazy National Center of Cancer Care and Research, Doha, Qatar R. Latifi (&) Department of Surgery, University of Arizona, Tucson, AZ, USA e-mail: [email protected]
Keywords Nutrition therapy Critically ill patients Intensive care unit Immune nutrition Immune-enhancing diet Immune-modulating diet
Introduction Nutrition support for critically ill and injured patients has undergone significant advances in recent decades—the direct result of scientific progress and our increased knowledge of the biology and biochemistry of key nutrient changes induced by injury, sepsis, and other critical illnesses, both in adults and in children. The science of nutrition support (or, more accurately, of nutrition therapy) has become more disease-based. Also called ‘‘specialized’’ or ‘‘artificial’’ nutrition support, nutrition therapy refers to the provision of either enteral nutrition (EN) via tube feeding or total parenteral nutrition (TPN). In contrast, ‘‘standard therapy’’ refers to a patient’s own volitional intake, without the provision of nutrition therapy [1]. Depending on the individual patient’s metabolic needs, nutrition therapy helps ensure that key nutrient substrates are replenished, or added in larger amounts, to supplement specific deficiencies or to simply prevent further deterioration and clinical consequences [2]. The benefit of early institution of either EN or TPN in the overall care of critically ill and injured patients has now been well established. After a critical illness or injury, the patient’
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