Skip to main content
SpringerLink
Log in
Book cover

From Nutrition Support to Pharmacologic Nutrition in the ICU pp 166–178Cite as

A Practical Approach to Feeding Intensive Care Patients

  • Chapter

  • 358 Accesses

Part of the book series: Update in Intensive Care Medicine ((UICMSOFT,volume 34))

Abstract

The conjunction of prolonged survival of critically ill patients and increased prevalence of malnutrition prior to hospitalization [1] represents a challenge to the ICU physician, faced with the difficult task of reconciling apparently opposed goals while trying to provide the best nutritional support to his patient [2–4]. Many nutritional issues still remain the subject of ongoing controversies [5–8], many of which are discussed in detail in other chapters of this book. These controversies notwithstanding, adequate nutritional support instituted early in the course of severe critical illness is regarded as an integral part of proper patient management [2]. To that end, various practical aspects must be considered, and it is the purpose of this chapter to provide the reader with such basic information derived from the published litterature and the authors’ experience [4, 9, 10]. In that perspective and with focus on practical issues, enteral and parenteral nutrition will first be considered independently, then their possible combined uses will be discussed. No attempt is made to review in depth all such issues, but emphasis will be placed on those most often referred to by ICU physicians in daily practice.

This is a preview of subscription content, 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   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
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

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Giner M, Laviano A, Meguid MM, Gleason JR (1996) In 1995 a correlation still exists between malnutrition and poor outcome in critically ill patients still exists. Nutrition 12: 23–29

    Article  PubMed  CAS  Google Scholar 

  2. Cerra FB, Benitez MR, Blackburn GL, et al. (1997) Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. Chest 111: 769–778

    Article  PubMed  CAS  Google Scholar 

  3. Klein S., Kinney J., Jeejeebhoy K., et al. (1997) Nutrition support in clinical practice: review of published data and recommendations for future research directions. JPEN 21: 133–156

    Article  CAS  Google Scholar 

  4. Jolliet P, Pichard C, Chevrolet JC (1998) Nutritional support in the ventilator-dependent patient. Eur Respir Mon 8: 84–113

    Google Scholar 

  5. Lipman TO (1998) Grains or veins: is enteral nutrition really better than parenteral nutrition? A look at the evidence. JPEN 22: 167–182

    Article  CAS  Google Scholar 

  6. Koretz RL (1994) Feeding controversies. In: Zaloga G (ed). Nutrition in critical care. Mosby. St. Louis, pp 283–296.

    Google Scholar 

  7. Koretz RL (1995) Nutritional supplementation in the ICU. How critical is nutrition for the critically III? Am J Respir Crit Care Med 151: 570–573

    PubMed  CAS  Google Scholar 

  8. Heyland D.K., Cook D.J., Guyatt G.H. (1994) Does the formulation of enteral feeding products influence infectious morbidity and mortality rates in the critically ill patient? A critical review of the evidence. Crit Care Med 22: 1192–1202

    Article  PubMed  CAS  Google Scholar 

  9. Jolliet P, Pichard C, Biolo G, et al. (1998) Enteral nutrition in intensive care patients: a practical approach. Intensive Care Med 24: 848–859

    Article  PubMed  CAS  Google Scholar 

  10. Pichard C, Kyle U, Chevrolet JC, et al. (1996) Lack of effects on muscle function of recombinant growth hormone in patients requiring prolonged mechanical ventilation: a prospective randomized controlled study. Grit Care Med 24: 403–413

    Article  CAS  Google Scholar 

  11. Gorman R, Morris J, Metz C, Mullen J (1993) The button jejunostomy for long-term jejunal feeding results of a prospective randomized trial. JPEN 17: 428–431

    Article  CAS  Google Scholar 

  12. Shike M, Latkany L, Gerdes H, Bloch A (1997) Direct percutaneous endoscopic jejunostomies for enteral feeding. Nutr Clin Pract 12: S38–S42

    Article  PubMed  CAS  Google Scholar 

  13. Stark SP, Sharpe JN, Larson GM (1991) Endoscopically placed nasoenteral feeding tubes. Indications and technique. Ann Surg 57: 203–205

    CAS  Google Scholar 

  14. Dive A, Moulart M, Jonard P, Jamart J, Mahieu P (1994) Gastroduodenal motility in mechanically ventilated critically ill patients: a manometric study. Crit Care Med 22: 441–447

    Article  PubMed  CAS  Google Scholar 

  15. Russell T, Brotman M, Norris F (1984) Percutaneous gastrostomy. Am J Surg 148: 132–137

    Article  PubMed  CAS  Google Scholar 

  16. Kadakia SC, Sullivan HO, Starnes E (1992) Percutaneous endoscopic gastrostomy or jenunostomy and the incidence of aspiration in 79 patients. Am J Surg 164: 114–118

    Article  PubMed  CAS  Google Scholar 

  17. Cogen R, Weinryb J, Pomerantz C, Fenstemacher P (1991) Complications of jenunostomy tube feeding in nursing home facility patients. Am J gastroenterol 86: 1610–1613

    PubMed  CAS  Google Scholar 

  18. Breach CL, Saldanha LG (1988) Tube feedings: a survey of compliance to procedures and complications. Nutr Clin Practice 3: 230–234

    Article  CAS  Google Scholar 

  19. Butters M, Campos AC, Meguid MM (1992) High frequency-low morbidity mechanical complications of tube feeding: a prospective study. Clin Nutr 11: 87–92

    Article  PubMed  CAS  Google Scholar 

  20. Anderton A (1993) Bacterial contamination of enteral feeds and feeding systems. Clin Nutr 12: S16–S32

    Article  Google Scholar 

  21. Levy J, Van Laethem Y, Verhaegen G, Perpête C, Butzler JP, Wenzel RP (1989) Contaminated enteral nutrition solutions as a cause of nosocomial bloodstream infection: a study using plasmid fingerprinting. JPEN 13: 228–234

    Article  CAS  Google Scholar 

  22. Caspary WF (1992) Physiology and pathophysiology of intestinal absorption. Am J Clin Nutr 55: 299S-308 S

    Google Scholar 

  23. Rees RG, Hare WR, Grimble GK, Frost PG, Silk DB (1992) Do patients with moderately impaired gastrointestinal function requiring enteral nutrition need a predigested nitrogen source? A prospective crossover controlled trial. Gut 33: 877–881

    Article  PubMed  CAS  Google Scholar 

  24. Heimburger DC, Geels WJ, Bilbrey J, Redden DT, Keeney C (1997) Effects of small-peptide protein enteral feedings on serum proteins and diarrhea in critically ill patients: a randomized trial. JPEN 21: 162–167

    Article  CAS  Google Scholar 

  25. Mowatt-Larssen CA, Brown RO, Wojtysiak SL, Kudsk KA (1992) Comparison of tolerance and nutritional outcome between a peptide and a standard enteral formula in critically ill, hypoalbuminemic patients. JPEN 16: 20–24

    Article  CAS  Google Scholar 

  26. Jones BJ, Lees R, Andrews J, Frost P, Silk DB (1983) Comparison of an elemental and polymeric enteral diet in patients with normal gastrointestinal function. Gut 24: 78–84

    Article  PubMed  CAS  Google Scholar 

  27. Aguilar-Nascimento JE, Garcia A, De Lima SA, Pereira ACC (1997) Effect of an elemental diet on the morphology of the colon in rats. Nutrition 14: 287–290

    Article  Google Scholar 

  28. Homan HH, Kemen M, Fuessenich C, Senkal M, Zumtobel V (1994) Reduction of diarrhea incidence by soluble fiber in patients receiving total or supplemental enteral nutrition. JPEN 18: 486–490 A Practical Approach to Feeding Intensive Care Patients 177

    Google Scholar 

  29. Scheppach W.M., Bartram H-P. (1993) Experimental evidence for and clinical implications of fiber and artificial enteral nutrition. Nutrition 9: 399–405

    PubMed  CAS  Google Scholar 

  30. Shenkin A. (1995) Trace elements and inflammatory response: implications for nutritional support. Nutrition 11: 100–105

    PubMed  CAS  Google Scholar 

  31. Berger MM, Cavadini C, Bart A, et al. (1992) Cutaneous zinc and copper losses in burns. Burns 18: 373–380

    Article  PubMed  CAS  Google Scholar 

  32. Kohn CL (1991) The relationship between enteral formula contamination and length of enteral delivery set usage. JPEN 15: 567–571

    Article  CAS  Google Scholar 

  33. Pittet D, Dharan S, Touveneau S, Sauvan V, Pernegger TV (1999) Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Med 26: 821–826

    Article  Google Scholar 

  34. Cohen RM, Weintraub A, DiMarino AJ, Cohen S (1994) Gastroesophageal reflux during gastrostomy feeding. Gastroenterology 106: 13–18

    PubMed  Google Scholar 

  35. Jones BJ, Payne S, Silk DB (1980) Indications for pump-assisted enteral feeding. Lancet 17: 1057–1058

    Article  Google Scholar 

  36. Ciocon JO, Galindo-Ciocon DJ, Tiessen C, Galindo D (1992) Continuous compared with intermittent tube feeding in the elderly. JPEN 16: 525–528

    Article  CAS  Google Scholar 

  37. Heyland DK, Tougas G, King D, Cook DJ (1996) Impaired gastric emptying in mechanically ventilated, critically ill patients. Intensive Care Med 22: 1339–1344

    Article  PubMed  CAS  Google Scholar 

  38. Ringel AF, Jameson GL, Foster ES (1995) Diarrhea in the intensive care patient. Crit Care Clin 11: 465–477

    PubMed  CAS  Google Scholar 

  39. Bleichner G, Bléhaut H, Mentec H, Moyse D (1997) Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. Intensive Care Med 23: 517–523

    Article  PubMed  CAS  Google Scholar 

  40. Pichard C, Roulet M (1984) Constant rate enteral nutrition in bucco-pharyngeal cancer care. A highly efficient nutritional support system. Clin Otolaryngol 9: 209–214

    Article  PubMed  CAS  Google Scholar 

  41. Bosscha K, Nieuwenhuijs VB, Vos A, Samson M, Roelofs JMM, Akkermans LMA (1998) Gastrointestinal motility and gastric tube feeding in mechanically ventilated patients. Crit Care Med 26: 1510–1517

    Article  PubMed  CAS  Google Scholar 

  42. Heyland D, Cook DJ, Winder B, Brylowski L, Van de Mark H, Guyatt G (1995) Enteral nutrition in the critically ill patient: a prospective survey. Crit Care Med 23: 1055–1060

    Article  PubMed  CAS  Google Scholar 

  43. Adam S, Batson S (1997) A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK. Intensive Care Med 23: 261–266

    Article  PubMed  CAS  Google Scholar 

  44. McClave SA, Snider HL, Lowen CC, et al. (1992) Use of residual volume for enteral feeding intolerance: prospective blinded comparison with physical examination and radiographic findings. JPEN 16: 99–105

    Article  CAS  Google Scholar 

  45. Lin HC, Van Citters GW (1997) Stoping enteral feeding for arbitrary gastric residual volume may not be physiologically sound: results of a computer simulation model. JPEN 21: 286–289

    Article  CAS  Google Scholar 

  46. Spapen HD, Duinslaeger L, Diltoer M, Gillet R, Bossuyt A, Huyghens LP (1995) Gastric emptying in critically ill patients is accelerated by adding cisapride to a standard enteral feeding protocol: results of a prospective, randomized, controlled trial. Crit Care Med 23: 481–485

    Article  PubMed  CAS  Google Scholar 

  47. Frost P, Edwards N, Bihari D (1997) Gastric emptying in the critically ill - the way forward? Intensive Care Med 23: 243–245

    Article  PubMed  CAS  Google Scholar 

  48. Fuhrman MP (1999) Diarrhea and tube feeding. Nutr Clin Pract 14: 83–84

    Article  Google Scholar 

  49. Heimburger DC (1990) Diarrhea in tube-fed patients: will the real cause please stand up. Am J Med 88: 89–90

    Article  PubMed  CAS  Google Scholar 

  50. Edes TE, Walk BE, Austin JL (1990) Diarrhea in tube-fed patients: feeding formula not necessarily the cause. Am J Med 88: 91–93

    Article  PubMed  Google Scholar 

  51. Keohane PP, Attrill H, Love M, Silk DB (1984) Relation between osmolality of diet and gastrointestinal side effects in enteral nutrition. Br Med J 288: 678–680

    Article  CAS  Google Scholar 

  52. Schlichtig R, Ayres SM (1988) Modes of delivery: rationale, implementation, and mechanical complications. In: Schlichtig R, Ayres S (ed). Nutritional support of the critically ill. Year Book Medical Publishers Inc. Chicago, London, Boca Raton, pp 75–95.

    Google Scholar 

  53. Giuffrida DJ, Bryan-Brown CW, Lumb PD, Kwun KB, Rhoades HM (1986) Central vs. peripheral venous catheters. Crit Care Med 90: 806–809

    CAS  Google Scholar 

  54. Reed CR, Sesler CN, Glauser FL, Phelan BA (1995) Central venous catheter infections: concepts and controversies. Intensive Care Med 21: 177–183

    Article  PubMed  CAS  Google Scholar 

  55. Cook D, Randolph A, Kernerman P, et al. (1997) Central venous catheter replacement strategies: a critical review of the literature. Crit Care Med 25: 1417–1424

    Article  PubMed  CAS  Google Scholar 

  56. Hansell DT (1989) Intravenous nutrition: the central or peripheral route? Int Ther Clin Monit 10: 184–190

    Google Scholar 

  57. Kemp CL, Burge J, Chonban P, Harden J, Mirtallo J, Flancbaum L (1994) The effect of catheter type and site on infection rate in total parenteral nutrition. JPEN 18: 71–74

    Article  CAS  Google Scholar 

  58. Thompson B, Robinson LA (1991) Infection control of parenteral nutrition solutions. Nutr Clin Pract 6: 49–51

    Article  PubMed  CAS  Google Scholar 

  59. Mehrson J, Nogami W, Williams JA, Yoder C, Eitzen HE, Lemons JA (1986) Bacterial/fungal growth in a combined parenteral nutrition solution. JPEN 10: 498–502

    Article  Google Scholar 

  60. Parr MD, Bertch KE, Rapp RP (1985) Amino acid stability and microbial growth in total par-enteral nutrient solutions. Am J Hosp Pharm 42: 2688–2691

    PubMed  CAS  Google Scholar 

  61. Leutenegger A, Frutiger A (1986) All-in-one: conventional versus two different all-in-one solutions for total parenteral nutrition surgical intensive care patients. World J Surg 10: 84–94

    Article  PubMed  CAS  Google Scholar 

  62. Baddeley J, Thomas M, Chatterjee R, Page C, Nicholas A (1996) Pharmacoeconomic analysis of a new TPN service compared with on-site hospital manufacture. Br J Int Care Oct: 290–296

    Google Scholar 

  63. Forsberg E, Soop M, Lepape A, Thörne A (1994) Metabolic and thermogenic response to continuous and cyclic total parenteral nutrition in traumatised and infected patients. Clin Nutr 13: 291–301

    Article  PubMed  CAS  Google Scholar 

  64. Lew JL, Rombeau JL (1993) Effects of enteral nutrients on the critically ill gut. In: Wilmore D, Carpentier Y (ed). Metabolic support of the critically ill patient. Springer-Verlag. Berlin, Heidelberg, New York, pp 175–197.

    Chapter  Google Scholar 

  65. Buchman AL, Moukarzel AA, Bhuta S, et al. (1995) Parenteral nutrition is associated with intestinal morphologic and functional changes in humans. JPEN 19: 453–460

    Article  CAS  Google Scholar 

  66. Frost P, Bihari D (1997) The route of nutritional support in the critically ill: physiological and economical considerations. Nutrition 13: 58S-63 S

    Article  Google Scholar 

  67. Weekes E, Elia M (1996) Observations on the patterns of 24-h energy expenditure changes in body composition and gastric emptying in head-injured patients receiving nasogastric tube feeding. JPEN 20: 31–37

    Article  CAS  Google Scholar 

  68. American Society for Parenteral and Enteral Nutrition (1993) Guidelines for the use of par-enteral and enteral nutrition in adult and pediatric patients. JPEN 17: 1SA–51SA

    Google Scholar 

  69. Zaloga GP, Black KW, Prielipp P (1992) Effect of rate of enteral nutrient supply on gut mass. JPEN 16: 39–42

    Article  CAS  Google Scholar 

  70. Arnold J, Campbell IT, Samuels TA, et al. (1993) Increased whole body protein breakdown predominates over increased whole body protein synthesis in multiple organ failure. Clin Sci 84: 655–661

    CAS  Google Scholar 

  71. Finn PJ, Plank LD, Clark MA, Connolly AB, Hill GL (1996) Progressive cellular dehydration and proteolysis in critically ill patients. Lancet 347: 654–656

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Soins Intensifs de Médecine, Hôpital Cantonal Universitaire, Geneva, Switzerland

    P. Jolliet

  2. Department of Clinical Nutrition, University Hospital, Geneva, Switzerland

    C. Pichard

Authors
  1. P. Jolliet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Pichard
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. University Hospital, 1211, Geneva 14, Switzerland

    Claude Pichard MD, PhD (Head of Clinical Nutrition) (Head of Clinical Nutrition)

  2. Department of Surgery, University of Wisconsin-Madison, Madison, WI 53706, USA

    Kenneth A. Kudsk MD (Professor of Surgery) (Professor of Surgery)

Rights and permissions

Reprints and permissions

Copyright information

© 2002 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Jolliet, P., Pichard, C. (2002). A Practical Approach to Feeding Intensive Care Patients. In: Pichard, C., Kudsk, K.A. (eds) From Nutrition Support to Pharmacologic Nutrition in the ICU. Update in Intensive Care Medicine, vol 34. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-57119-0_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-57119-0_14

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-42604-2

  • Online ISBN: 978-3-642-57119-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation