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Diet and nutrition in critical care,diet chicken recipes lose weight,fruit diet pills - How to DIY

Understand current concepts in pediatric nutrition and barriers to achieving optimal therapy.
The importance of an optimal diet in preventing illness and maintaining wellness has been recognized since the times of Hippocrates, but optimal nutritional therapy in the critically ill child remains a distant goal in the complex intensive care unit (ICU) environment. The goal of optimal nutrition during critical illness is to augment the short-term beneficial effects of the stress response to injury or illness, and to minimize the long-term harmful consequences of a protracted stress response.
Energy Prescription and Balance in the PICUEnergy intake during critical illness needs careful attention, especially the paradigm of using standard equations for estimating energy needs.
Challenges at the BedsideOnce EN is initiated in the critically ill child, multiprofessional commitment is required to advance to the nutritional goal and then maintain feeding during the course of illness. Future DirectionsOptimizing nutritional therapy is a low-cost intervention with the potential for improving outcomes during critical illness in children.
The scarcity of well-conducted clinical trials, heterogeneity in bedside practice and overall reluctance to prioritize nutritional therapy are significant hurdles to achieving nutritional goals in the pediatric ICU (PICU). Clearly, well-conducted multicenter studies in pediatric critical care nutrition are needed urgently. The response to injury is manifested by protein catabolism, releasing free amino acids that undergo reprioritization to tissue repair and inflammatory response pathways.(2) This adaptive catabolic response can deplete protein stores, causing lean body mass depletion if matching protein intake and optimal energy are not provided. Fluid restriction, fasting for procedures, perceived intolerance and problems with enteral access are some of the challenges that prevent uninterrupted delivery of nutrients in the PICU.(14,15) Many of these interruptions are avoidable with consistency in practice, education and realignment of priorities.
Increased awareness of the role of nutrition, as well as a multiprofessional effort, will ensure that nutritional goals are achieved in the PICU population.
A careful investigative approach, using sound clinical design and multicenter collaboration, may elucidate the role of immunonutrients, such as glutamine and fish oils, in improving outcomes during pediatric critical illness.


Understanding the current concepts of nutritional therapy and addressing common barriers to optimal nutrient therapy in the PICU may help overcome some of these hurdles. In the absence of rigorous evidence, clinicians might benefit from uniform and prudent feeding strategies based on the best available evidence and multiprofessional expert consensus. Indeed, in a large multicenter study of nutrition intake in mechanically ventilated children, an average of only 50% of the prescribed energy was actually delivered by the end of seven days following PICU admission (Mehta N., personal communication). Screening on admission to detect patients who are either malnourished or at risk of nutritional deterioration is the first step. Children with existing nutritional deficiencies are the most likely to benefit from these interventions.
Resting energy expenditure in children in a pediatric intensive care unit: comparison of Harris-Benedict and Talbot predictions with indirect calorimetry values.
Pitfalls in predicting resting energy requirements in critically ill children: a comparison of predictive methods to indirect calorimetry.
Cumulative energy imbalance in the pediatric intensive care unit: role of targeted indirect calorimetry. Predicted energy expenditure in critically ill children: problems associated with increased variability.
Stable isotopic quantitation of protein metabolism and energy expenditure in neonates on- and post-extracorporeal life support. Challenges to optimal enteral nutrition in a multidisciplinary pediatric intensive care unit.
Once energy and protein goals are identified, enteral nutrition (EN) is the preferred mode of nutrient delivery in a hemodynamically stable patient with a functioning gut.


Indirect calorimetry, when feasible, provides accurate energy expenditure measurements and guides intake.
Children with avoidable interruptions to EN during their PICU stay take longer to reach the nutritional goal, are more likely to need PN and may have poorer outcomes compared to the rest.(14) Nutritional goals must be reviewed on daily bedside rounds and barriers addressed by the multiprofessional team.
Accurate and sequential assessment of energy and protein requirements, delivery of nutrients early via the enteral route when feasible, protocolized advancement of feedings to goal, and attention to common hurdles are prudent measures to ensure optimal nutrient delivery. Other areas needing urgent clarification include the definition and management of intolerance to EN, the role of energy balance on clinical outcomes, the role of protein supplementation and nitrogen balance in preserving lean body mass during critical illness, and the indications and benefits of small bowel feeding in the PICU.
It is generally believed that EN improves gut integrity and motility, maintains enterocyte mass and mesenteric blood flow, and is associated with lower morbidity rates compared to parenteral nutrition (PN).
Nutritional status, adequacy of macronutrient and micronutrient intake, and nutritional goals must be discussed as part of a daily checklist during PICU patient rounds. In the interim, it is important to adhere to prudent nutrition practices at the bedside and to recognize the role of nutrition therapy as a critical component of care. The presence of a dedicated dietitian on the unit facilitates the timely institution of appropriate nutrition therapy. Pediatric critical care nutrition must be recognized as a discrete discipline in which all trainees should reach a minimum level of competence.



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