Advertisement

Nutrition in the Critically Ill Obstetric Patient

  • Kamini A. Rao
  • Smitha Avula
Chapter

Abstract

Nutrition in a critically ill patient is a challenge in itself; altered metabolism in pregnancy with the superadded stress of critical illness makes the scenario more complex, vis-a-vis catering to adequate fetal nutrition for optimal growth of the fetus. Different phases of critical illness, representing varying metabolic states from high fuel demand catabolic state to a more steady plateau phase and into a prolonged anabolic state, should be borne in mind while planning nutritional support; customized nutritional plans have to be catered to in specific overlapping scenarios with pregnancy as in acute renal failure and inflammatory bowel disease. Judicial use of enteral vs parentral nutrition can optimize nutrition and minimize complications. The implications of nutritional support in CIPP extend beyond the horizon of mere provision of calories but maintaining the metabolic milieu of pregnancy catering to the needs of both the mother and her unborn fetus and combating the critical illness.

Keywords

Renal Replacement Therapy Critical Illness Enteral Nutrition Nutritional Support Short Bowel Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Information Kit, World Health Day 1998. World Health Organization. Available from: http://www.who.ch/whday/1998/index.html.
  2. 2.
    WHO, UNICEF, UNFPA, The World Bank, and the United Nations Population Division. Trends in maternal mortality: 1990 to 2013. Geneva: World Health Organization; 2014.Google Scholar
  3. 3.
    Lain KY, Catalano PM. Metabolic changes in pregnancy. Clin Obstet Gynecol. 2007;50(4):938–48.Google Scholar
  4. 4.
    Green top guideline no. 56, Maternal collapse in pregnancy and puerperium. Royal College of Obstetrics and Gynecology, January 2011.Google Scholar
  5. 5.
    Preiser JC, Ichai C, Orban JC, Groeneveld AB. Metabolic response to the stress of critical illness. Br J Anaesth. 2014;113(6):945–54.Google Scholar
  6. 6.
    Lena D, Kalfon P, Preiser JC, Ichai C. Glycemic control in the intensive care unit and during the postoperative period. Anesthesiology. 2011;114:438–44.CrossRefPubMedGoogle Scholar
  7. 7.
    Biolo G, Grimble G, Preiser JC, European Society of Intensive Care Medicine Working Group on Nutrition and Metabolism, et al. Position paper of the ESICM working group on nutrition and metabolism. Metabolic basis of nutrition in intensive care unit patients: ten critical questions. Intensive Care Med. 2002;28:1512–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Mowery NT, Dortch MJ, Dossett LA, et al. Insulin resistance despite tight glucose control is associated with mortality in critically ill surgical patients. J Intensive Care Med. 2009;24:242–51.CrossRefPubMedGoogle Scholar
  9. 9.
    Fraipont V, Preiser JC. Energy estimation and measurement in critically ill patients. J Parenter Enteral Nutr. 2013;37:705–13.CrossRefGoogle Scholar
  10. 10.
    Vincent JL, Preiser JC. When should we add parenteral to enteral nutrition? Lancet. 2013;381:354–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Heidegger CP, Berger MM, Graf S, et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013;381:385–93.CrossRefPubMedGoogle Scholar
  12. 12.
    Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365:506–17.CrossRefPubMedGoogle Scholar
  13. 13.
    Schetz M, Casaer MP, Van den Berghe G. Does artificial nutrition improve outcome of critical illness? Crit Care. 2013;17:302.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Pamplin JC, Murray SJ, Chung KK. Phases-of-illness paradigm: better communication, better outcomes. Crit Care. 2011;15:309.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wilmore DW, Long JM, Mason AD, Skreen RW, Pruitt BA. Catecholamines mediator of the hypermetabolic response to thermal in injury. Ann Surg. 1974;180:653–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Gariballa S, Forster S. Energy expenditure of acutely ill hospitalized patients. Nutr J. 2006;5:1–5.CrossRefGoogle Scholar
  17. 17.
    Long CL, Schaffel N, Geiger JW, Schiller WR, Blakemore WS. Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. J Parenter Enteral Nutr. 1979;3:452–6.CrossRefGoogle Scholar
  18. 18.
    Frankenfield DC, Wiles CE, Bagley S, Siegel JH. Relationships between resting and total energy expenditure in injured and septic patients. Crit Care Med. 1995;22:1796–804.CrossRefGoogle Scholar
  19. 19.
    Makrides M, Duley L, Olsen SF. Marine oil, and other prostaglandin precursor, supplementation for pregnancy uncomplicated by pre-eclampsia or intrauterine growth restriction. Cochrane Database Syst Rev. 2006;3:CD003402.PubMedGoogle Scholar
  20. 20.
    Lewin GA, Schachter HM, Yuen D, Merchant P, Mamaladze V, Tsertsvadze A. Effects of omega-3 fatty acids on child and maternal health. Evid Rep Technol Assess. 2005;118:1–11.Google Scholar
  21. 21.
    Kris-Etherton PM, Innis S. Position of the American Dietetic Association and Dietitians of Canada: dietary fatty acids. J Am Diet Assoc. 2007;107:1599–611. 2007.CrossRefPubMedGoogle Scholar
  22. 22.
    Mendieta Zeron H, Gabriela H, Layton CF. The adiponectin/leptin ratio is an useful tool to evaluate the metabolic status in an obstetric ICU. Rom J Int Med. 2013;51(2):107–13.Google Scholar
  23. 23.
    Cano NJM, Aparicio M, Brunori G. Guideline on parentral nutrition in acute renal failure. ESPEN guidelines. Clin Nutr. 2009;28(4):401–14.Google Scholar
  24. 24.
    Dragomir C, Grigoras I. Role of nutrition in the management of inflammatory bowel disease – current status. Ann Gastroenterol. 2007;20(4):246–50.Google Scholar
  25. 25.
    Triantafillidis JK, Papalois AE. The role of total parenteral nutrition in inflammatory bowel disease: current aspects. Scand J Gastroenterol. 2014;49(1):3–14.CrossRefPubMedGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Milann the Fertility CenterBengaluruIndia

Personalised recommendations