Document Detail

Nutrition delivery for obese ICU patients: delivery issues, lack of guidelines, and missed opportunities.
MedLine Citation:
PMID:  21881018     Owner:  NLM     Status:  In-Data-Review    
The most appropriate enteral formula for the severely obese population has yet to be determined. The obese patient in the intensive care unit (ICU) creates numerous difficulties for managing care, one being the ability to deliver appropriate and timely nutrition. Access for nutrition therapy, either enteral or parenteral, can also create a challenge. Currently, no specific guidelines are available on a national or international scale to address the issues of how and when to feed the obese patient in the ICU. A bias against feeding these patients exists, secondary to the perception that an enormous quantity of calories is stored in adipose tissue. Making a specialty enteral formula for obesity from existing commercial formulas and other modular nutrient components is not practical, secondary to difficulty with solubility issues, dilution of the formula, and safety concerns. Using today's concepts and current metabolic data, a formula could be produced that would address many of the specific metabolic derangements noted in obesity. This formula should have a high-protein, low-carbohydrate content with at least a portion of the lipid source coming from fish oil. Specific nutrients that may be beneficial in obesity include arginine, glutamine, leucine, L-carnitine, lipoic acid, S-adenosylmethionine, and betaine. Certain trace minerals such as magnesium, zinc, and selenium may also be of value in the obese population. The concept of a specific bariatric formulation for the ICU setting is theoretically sound, is scientifically based, and could be delivered to patients safely.
Robert G Martindale; Mark Delegge; Stephen McClave; Craig Monroe; Vance Smith; Laszlo Kiraly
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JPEN. Journal of parenteral and enteral nutrition     Volume:  35     ISSN:  0148-6071     ISO Abbreviation:  JPEN J Parenter Enteral Nutr     Publication Date:    2011 Sep-Oct
Date Detail:
Created Date:  2011-09-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7804134     Medline TA:  JPEN J Parenter Enteral Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  80S-7S     Citation Subset:  IM    
Department of Surgery, Oregon Health and Sciences University, Portland, Oregon.
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