Supportive Care Considerations and Nutrition Support for Critically Ill Cancer Patients
Protein-calorie malnutrition is frequently observed in elderly cancer patients admitted to the intensive care unit (ICU). The use of nutrition support in these patients is dictated through nutritional assessment and utilization of an available feeding access device, whether enteral or parenteral. Provision of hypocaloric regimens less than 20 kcal/kg/day with at least 1.2 g protein/kg/day is recommended in the 1st week of ICU care. Complications observed in the ICU cancer patient receiving nutrition support are primarily related to their underlying degree of malnutrition and comorbidities. The identification and management of hyperglycemia, electrolyte abnormalities, and vitamin deficiencies associated with refeeding syndrome in this ICU cancer population is of utmost importance.
KeywordsMalnutrition Enteral nutrition Parenteral nutrition Refeeding syndrome Vomiting Diarrhea Constipation Aspiration Hyperglycemia
- 1.American Diabetes Association. Diabetes care in the hospital. 2016;39. https://doi.org/10.2337/dc16-S016.
- 2.Atasever AG, Ozcan PE, Kasali K, Abdullah T, Orhun G, Senturk E. The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients. Ther Clin Risk Manag. 2018;14:385–91. https://doi.org/10.2147/tcrm.S158492.CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Barrett ML, BM, Owens PL. Non-maternal and non-neonatal inpatient stays in the United States involving malnutrition. 2018;2016:1–27. www.hcup-us.ahrq.gov/reports.jsp
- 5.Bisanz A, Tucker AM, Amin DM, Patel D, Calderon BB, Joseph MM, Curry EA 3rd. Summary of the causative and treatment factors of diarrhea and the use of a diarrhea assessment and treatment tool to improve patient outcomes. Gastroenterol Nurs. 2010;33: 268–81; quiz 282–263. https://doi.org/10.1097/SGA.0b013e3181e94307.CrossRefPubMedGoogle Scholar
- 12.Doig GS, et al. Restricted versus continued standard caloric intake during the management of refeeding syndrome in critically ill adults: a randomised, parallel-group, multicentre, single-blind controlled trial. Lancet Respir Med. 2015;3:943–52. https://doi.org/10.1016/S2213-2600(15)00418-X.CrossRefPubMedGoogle Scholar
- 18.Greenwood J. Critical care nutrition at the clinical valuation research unit. Study tools: management of diarrhea algorithm. 2010. www.criticalcarenutrition.org/docs/tools/diarrhea.pdf. Accessed 6 June 2018.
- 26.Malone AM, Seres D, Lord LM. Complications of enteral nutrition. In: Mueller CM, editor. The ASPEN adult nutrition support core curriculum. 3rd ed. Silver Spring: American Society for Parenteral and Enteral Nutrition; 2017. p. 265–83.Google Scholar
- 28.McClave SA, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40:159–211. https://doi.org/10.1177/0148607115621863.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Mirtallo J. Overview of parenteral nutrition. In: Gottschlich MM, editor. The A.S.P.E.N. Nutrition support core curriculum: a case-based approach – the adult patient. 2nd ed. Silver Spring: The American Society for Parenteral and Enteral Nutrition; 2007. p. 265–75.Google Scholar
- 37.Roberts S, Mattox T. Cancer. In: Gottschlich MM, editor. The A.S.P.E.N. Nutrition support core curriculum: a case-based approach – the adult patient. 2nd ed. Silver Spring: American Society for Parenteral and Enteral Nutrition; 2007. p. 650–75.Google Scholar