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VOLUME 22 , ISSUE 4 ( 2018 ) > List of Articles

GUIDELINES

Practice guidelines for nutrition in critically Ill patients: A relook for indian scenario

Sunil Garg, J.D. Sunavala, Sanghamitra Chakravarti, Tanmay Banerjee, Anshu Joshi, Ganesh Kadhe

Keywords : Critically ill patients, enteral nutrition, guidelines, scientific formula, tube feeding

Citation Information : Garg S, Sunavala J, Chakravarti S, Banerjee T, Joshi A, Kadhe G. Practice guidelines for nutrition in critically Ill patients: A relook for indian scenario. Indian J Crit Care Med 2018; 22 (4):263-273.

DOI: 10.4103/ijccm.IJCCM_3_18

License: CC BY-ND 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Background and Aim: Intensive-care practices and settings may differ for India in comparison to other countries. While international guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to Indian settings. Advisory board meetings were arranged to develop the practice guidelines specific to Indian context, for the use of EN in critically ill patients and to overcome challenges in this field. Methods: Various existing guidelines, meta-analyses, randomized controlled trials, controlled trials, and review articles were reviewed for their contextual relevance and strength. A systematic grading of practice guidelines by advisory board was done based on strength of the supporting evidence. Wherever Indian studies were not available, references were taken from the international guidelines. Results: Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding EN versus parenteral nutrition; nutrition screening and assessment; nutrition in hemodynamically unstable; route of nutrition; tube feeding and challenges; tolerance; optimum calorie-protein requirements; selection of appropriate enteral feeding formula; micronutrients and immune-nutrients; standard nutrition in hepatic, renal, and respiratory diseases and documentation of nutrition practices. Conclusion: This paper summarizes the optimum nutrition practices for critically ill patients. The possible solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance in critical care settings regarding appropriate critical-care nutrition practices and to set up Intensive Care Unit nutrition protocols.

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  1. Maday KR. The importance of nutrition in critically ill patients. JAAPA 2017;30:32-7.
  2. Dumlu EG, Özdedeoğlu M, Bozkurt B, Tokaç M, Yalçin A, Öztürk L, et al. Ageneral consideration of the importance of nutrition for critically ill patients. Turk J Med Sci 2014;44:1055-9.
  3. Yang S, Wu X, Yu W, Li J. Early enteral nutrition in critically ill patients with hemodynamic instability: An evidence-based review and practical advice. Nutr Clin Pract 2014;29:90-6.
  4. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, 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.
  5. Campos BB, Machado FS. Nutrition therapy in severe head trauma patients. Rev Bras Ter Intensiva 2012;24:97-105.
  6. Jolliet P, Pichard C, Biolo G, Chioléro R, Grimble G, Leverve X, et al. Enteral nutrition in intensive care patients: A practical approach. Working Group on Nutrition and Metabolism, ESICM. European Society of Intensive Care Medicine. Intensive Care Med 1998;24:848-59.
  7. Cook AM, Peppard A, Magnuson B. Nutrition considerations in traumatic brain injury. Nutr Clin Pract 2008;23:608-20.
  8. Flordelís Lasierra JL, Pérez-Vela JL, Montejo González JC. Enteral nutrition in the hemodynamically unstable critically ill patient. Med Intensiva 2015;39:40-8.
  9. Wells DL. Provision of enteral nutrition during vasopressor therapy for hemodynamic instability: An evidence-based review. Nutr Clin Pract 2012;27:521-6.
  10. Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P; Canadian Critical Care Clinical Practice Guidelines Committee, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 2003;27:355-73.
  11. Hensurd DD. Nutrition screening and assessment. Med Clin North Am 1999;83:1525-46.
  12. Fontes D, Generoso Sde V, Toulson Davisson Correia MI. Subjective global assessment: A reliable nutritional assessment tool to predict outcomes in critically ill patients. Clin Nutr 2014;33:291-5.
  13. Tapiawala S, Vora H, Patel Z, Badve S, Shah B. Subjective global assessment of nutritional status of patients with chronic renal insufficiency and end stage renal disease on dialysis. J Assoc Physicians India 2006;54:923-6.
  14. Nutrition Support for Adults: Oral Nutrition Support, Enteral tube Feeding and Parenteral Nutrition NICE Clinical Guidelines, No 32 National Collaborating Centre for Acute Care (UK); 2006. Available from: https://www.nice.org.uk/guidance/cg32. [Last updated on 2017 Aug 17; Last accessed on 2017 Sep 19].
  15. Rungta N. ICU Planning and Designing in India-Guidelines 2010; 2010. Available from: http://www.isccm.org/images/Section1.pdf. [Last accessed on 2017 Sep 19].
  16. Prado CM, Heymsfield SB. Lean tissue imaging: A new era for nutritional assessment and intervention. JPEN J Parenter Enteral Nutr 2014;38:940-53.
  17. A.S.P.E.N. Practice Management Task Force, Delegge M, Wooley JA, Guenter P, Wright S, Brill J, et al. The state of nutrition support teams and update on current models for providing nutrition support therapy to patients. Nutr Clin Pract 2010;25:76-84.
  18. Guttormsen AB, Pichard C. Determining energy requirements in the ICU. Curr Opin Clin Nutr Metab Care 2014;17:171-6.
  19. Preiser JC, van Zanten AR, Berger MM, Biolo G, Casaer MP, Doig GS, et al. Metabolic and nutritional support of critically ill patients: Consensus and controversies. Crit Care 2015;19:35.
  20. Kozar R, Moore F. McQuiggan M. Nutritional support of the stressed ICU patient. ACCP Critical Care Board Review. 2003; p. 439-61.
  21. Darton A. Clinical Practice Guidelines Nutrition Burn Patients Management-NSW Statewide Burn Injury Service. Agency for Clinical Innovation; 2011. p. 3. Available from: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0009/162639/SBIS_Nutrition_CPG_new_format.pdf. [Last accessed on 2017 Sep 19].
  22. Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, et al. ESPEN guidelines on enteral nutrition: Intensive care. Clin Nutr 2006;25:210-23.
  23. Elke G, van Zanten AR, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, et al. Enteral versus parenteral nutrition in critically ill patients: An updated systematic review and meta-analysis of randomized controlled trials. Crit Care 2016;20:117.
  24. Dhaliwal R, Jurewitsch B, Harrietha D, Heyland DK. Combination enteral and parenteral nutrition in critically ill patients: Harmful or beneficial? A systematic review of the evidence. Intensive Care Med 2004;30:1666-71.
  25. Gopalan S, Khanna S. Enteral nutrition delivery technique. Curr Opin Clin Nutr Metab Care 2003;6:313-7.
  26. White H, King L. Enteral feeding pumps: Efficacy, safety, and patient acceptability. Med Devices (Auckl) 2014;7:291-8.
  27. Schröder S, van Hülst S, Claussen M, Petersen K, Pich B, Bein B, et al. Postpyloric feeding tubes for surgical intensive care patients. Pilot series to evaluate two methods for bedside placement. Anaesthesist 2011;60:214-20.
  28. McClave SA, DiBaise JK, Mullin GE, Martindale RG. ACG clinical guideline: Nutrition therapy in the adult hospitalized patient. Am J Gastroenterol 2016;111:315-34.
  29. Pirlich M, Smoliner C. Approach to Oral and Enteral Nutrition (PN) in Adults. ESPEN LLL Programme; 2016. Available from: http://www.lllnutrition.com/mod_lll/TOPIC8/m84.pdf. [Last accessed on 2017 Sep 19].
  30. Baniardalan M, Sabzghabaee AM, Jalali M, Badri S. Bacterial safety of commercial and handmade enteral feeds in an Iranian teaching hospital. Int J Prev Med 2014;5:604-10.
  31. Larentis DZ, Rosa RG, Dos Santos RP, Goldani LZ. Outcomes and risk factors associated with clostridium difficile diarrhea in hospitalized adult patients. Gastroenterol Res Pract 2015;2015:346341.
  32. Sullivan MM, Sorreda-Esguerra P, Santos EE, Platon BG, Castro CG, Idrisalman ER, et al. Bacterial contamination of blenderized whole food and commercial enteral tube feedings in the Philippines. J Hosp Infect 2001;49:268-73.
  33. Mokhalalati JK, Druyan ME, Shott SB, Comer GM. Microbial, nutritional and physical quality of commercial and hospital prepared tube feedings in Saudi Arabia. Saudi Med J 2004;25:331-41.
  34. Jalali M, Sabzghabaee AM, Badri SS, Soltani HA, Maracy MR. Bacterial contamination of hospital-prepared enteral tube feeding formulas in Isfahan, Iran. J Res Med Sci 2009;14:149-56.
  35. Dickerson RN, Boschert KJ, Kudsk KA, Brown RO. Hypocaloric enteral tube feeding in critically ill obese patients. Nutrition 2002;18:241-6.
  36. Kim H, Shin JA, Shin JY, Cho OM. Adequacy of nutritional support and reasons for underfeeding in neurosurgical Intensive Care Unit patients. Asian Nurs Res (Korean Soc Nurs Sci) 2010;4:102-10.
  37. Seron-Arbeloa C, Zamora-Elson M, Labarta-Monzon L, Mallor-Bonet T. Enteral nutrition in critical care. J Clin Med Res 2013;5:1-1.
  38. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, 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.
  39. Araújo-Junqueira L, De-Souza DA. Enteral nutrition therapy for critically ill adult patients; critical review and algorithm creation. Nutr Hosp 2012;27:999-1008.
  40. Ellis RJ.In vitro Comparison of Gastric Aspirate Methods and Feeding Tube Properties on the Quantity and Reliability of Obtained Aspirate Volume. Indiana University. Available from: https://www.scholarworks.iupui.edu/bitstream/handle/1805/3690/Bartlett_Ellis_Dissertation_2013a.pdf. [Last accessed on 2017 Sep 19].
  41. Guo B. Gastric residual volume management in critically ill mechanically ventilated patients: A literature review. Proc Singapore Healthc 2015;24:171-80.
  42. Rice TW. Gastric residual volume: End of an era. JAMA 2013;309:283-4.
  43. Brown B, Roehl K, Betz M. Enteral nutrition formula selection: Current evidence and implications for practice. Nutr Clin Pract 2015;30:72-85.
  44. Intensive Care Society of Ireland. Critical Care Programme Nutrition Support (Adults) Reference Document. Irish Nutrition and Dietetic Institute; 2012. Available from: http://www.criticalcarenutrition.com/docs/BOB/ReferenceDoc.pdf. [Last accessed on 2017 Sep 19].
  45. ICU Enteral Feeding Guidelines [Internet] Available from: www.surgicalcriticalcare.netGuidelinesICU%20nutrition%202017.pdf. [Last revised on 2017 Sep 04; Last cited on 2017 Sep 19].
  46. Diarrheal Disease. Switzerland, Geneva: World Health Organization Media Centre. Available from: http://www.who.int/mediacentre/ factsheets/fs330/en. [Last updated on 2017 May; Last accessed on 2017 Sep 19].
  47. de Brito-Ashurst I, Preiser JC. Diarrhea in critically ill patients: The role of enteral feeding. JPEN J Parenter Enteral Nutr 2016;40:913-23.
  48. Taylor BE, McClave SA, Martindale RG, Warren MM, Johnson DR, Braunschweig C, 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.). Crit Care Med 2016;44:390-438.
  49. Tarleton SM, Kraft CA, DiBaise JK. Fiber-enriched enteral formulae: Advantageous or adding fuel to the fire? Pract Gastroenterol 2013;124:11-22.
  50. Manzanares W, Dhaliwal R, Jiang X, Murch L, Heyland DK. Antioxidant micronutrients in the critically ill: A systematic review and meta-analysis. Crit Care 2012;16:R66.
  51. Bajwa SJ. The underestimated nutritional aspects of micronutrients supplementation in intensive care. J Med Nutr Nutraceut 2013;2:114-6.
  52. Angstwurm MW, Gaertner R. Practicalities of selenium supplementation in critically ill patients. Curr Opin Clin Nutr Metab Care 2006;9:233-8.
  53. Dabhi L, Dabhi A. The role of micronutrients in ICU. GMJ 2014;69:32-4.
  54. Lee JG, Kim YS, Lee YJ, Ahn HY, Kim M, Kim M, et al. Effect of immune-enhancing enteral nutrition enriched with or without beta-glucan on immunomodulation in critically ill patients. Nutrients 2016;8. pii: E336.
  55. Chen QH, Yang Y, He HL, Xie JF, Cai SX, Liu AR, et al. The effect of glutamine therapy on outcomes in critically ill patients: A meta-analysis of randomized controlled trials. Crit Care 2014;18:R8.
  56. Wernerman J. Glutamine supplementation to critically ill patients? Crit Care 2014;18:214.
  57. Bémeur C, Desjardins P, Butterworth RF. Role of nutrition in the management of hepatic encephalopathy in end-stage liver failure. J Nutr Metab 2010;2010:489823.
  58. Eghtesad S, Poustchi H, Malekzadeh R. Malnutrition in liver cirrhosis: The influence of protein and sodium. Middle East J Dig Dis 2013;5:65-75.
  59. Rai R, Nagral S, Nagral A. Surgery in a patient with liver disease. J Clin Exp Hepatol 2012;2:238-46.
  60. Krenitsky J. Nutrition for patients with hepatic failure. Pract Gastroenterol 2003;6:23-42.
  61. Plauth M, Cabré E, Riggio O, Assis-Camilo M, Pirlich M, Kondrup J, et al. ESPEN guidelines on enteral nutrition: Liver disease. Clin Nutr 2006;25:285-94.
  62. Vizzini A, Aranda-Michel J. Nutritional support in head injury. Nutrition 2011;27:129-32.
  63. Horn SD, Kinikini M, Moore LW, Hammond FM, Brandstater ME, Smout RJ, et al. Enteral nutrition for patients with traumatic brain injury in the rehabilitation setting: Associations with patient preinjury and injury characteristics and outcomes. Arch Phys Med Rehabil 2015;96:S245-55.
  64. Itoh M, Tsuji T, Nemoto K, Nakamura H, Aoshiba K. Undernutrition in patients with COPD and its treatment. Nutrients 2013;5:1316-35.
  65. Pingleton SK. Enteral nutrition in patients with respiratory disease. Eur Respir J 1996;9:364-70.
  66. Rawal G, Yadav S. Nutrition in chronic obstructive pulmonary disease: A review. J Transl Int Med 2015;3:151-4.
  67. Hattiholi J, Gaude GS. Prevalence and correlates of osteoporosis in chronic obstructive pulmonary disease patients in India. Lung India 2014;31:221-7.
  68. Jørgensen NR, Schwarz P, Holme I, Henriksen BM, Petersen LJ, Backer V, et al. The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: A cross sectional study. Respir Med 2007;101:177-85.
  69. Anker SD, John M, Pedersen PU, Raguso C, Cicoira M, Dardai E, et al. ESPEN guidelines on enteral nutrition: Cardiology and pulmonology. Clin Nutr 2006;25:311-8.
  70. Lewington A, Kanagasundaram S. Renal association clinical practice guidelines on acute kidney injury. Nephron Clin Pract 2011;118 Suppl 1:c349-90.
  71. Case J, Khan S, Khalid R, Khan A. Epidemiology of acute kidney injury in the Intensive Care Unit. Crit Care Res Pract 2013;2013:479730.
  72. Fiaccadori E, Cremaschi E, Regolisti G. Nutritional assessment and delivery in renal replacement therapy patients. Semin Dial 2011;24:169-75.
  73. Downs J. Nutritional management of acute kidney injury in the critically ill: A focus on enteral feeding. S Afr J Clin Nutr 2014;27:187-93.
  74. Fiaccadori E, Regolisti G, Cabassi A. Specific nutritional problems in acute kidney injury, treated with non-dialysis and dialytic modalities. NDT Plus 2010;3:1-7.
  75. Arabi YM, Aldawood AS, Haddad SH, Al-Dorzi HM, Tamim HM, Jones G, et al. Permissive underfeeding or standard enteral feeding in critically ill adults. N Engl J Med 2015;373:1281.
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