Nutritional therapy in the critically ill patient

Abstract

Nutritional therapy (NT) has a positive impact in the critical ill patient evolution. However, the success depends on the adequate route selection, definition of protein and caloric recommendations, diet infusion techniques and NT monitoring. The NT has to be established in the first 24-48 hours, preferably by enteral route, especially in malnurish patients and/or with intense cathabolism and when has no prevision to adequate oral ingestion in 3-5 days. In the enteral nutrition, there is no advantages in the post piloric nasoenteral catheter position with regard to gastric in critical ill patient, but patients with broncoaspiration risc or gastric intolerance needs and individual evaluation. About the nutritional formula, the polimeric diets are apropriated to the majority of patients. The oligomeric diets use is indicated in patients with persistent diarrhea after exclusion of specific treatment causes (hyperosmotic medications, Clostridium difficile). To caloric and protein prescription, the recomendations is to follow international guidelines. Regarding the fiber prescription, in patients with diarrhea it is suggested soluble fiber use in enteral nutrition, but insoluble fiber must be avoided in all critical patients. Finishing the trials to use the digestive tube without reaching the nutritional goals or being it contraindicated, the parenteral nutrition must be utilized. The objective of this review is to present and to diffuse the NT in the critical ill patient in a practical and adequate way.