The focus of this study is based on an adults ICU environment focusing on diet. It assesses evidence in regards to the caloric goals for the ICU patients. It explores areas such as permissive feeding which is usually feeding patients with between 40-60% of the estimated caloric requirements and eucaloric feeding where the patients are provided with between 70 to 100% of the caloric requirement. It is worth noting that patients in ICU may not consume all of the food presented to them due to the level of infection, feeding tolerance and other factors that may influence their level of food intake. In such cases, an appropriate nutrient intake among the critically ill patients is a crucial determinant of care delivery. Malnutrition among students is usually associated with the impaired immune system. It may result in reduced ventilator drive and weakening of the respiratory muscles. Nutritional support is required if these challenges are to be fully addressed. According to the article by Charles et al. (2014), the caloric provision does not seem to influence outcomes as the caloric levels remain elusive and do not seem to influence the rate of infectious complications among such patients. According to Wischmeyer (2015) nevertheless notes that permissive feeding in the first week of patients in the ICU increases mortality and impairs the long-term quality of life. It is often too late for such patients to recover the calorie and nutrients debt when deprived in their earlier days of acceptance into the ICU. The views of these scholars seem to somehow contradict and hence it is important to carry out more research on the issue from other primary sources as evident in this study. It is important to understand the importance of maintaining requisite nutrients intake and calories and the effects that lack the same has on ICU patients.
Primary article 1
Literature assessment
The article is developed by Rugeles et al. (2013). The main aim of the article was to evaluate the impact of hyperproteic hypocaloric enteral feeding has on the clinical outcomes especially in the critically ill patients. The author has consulted literature to gain a solution to the issue. According to the review of the literature, the authors noted that there is evidence suggesting that increased rate of complications among the patients in the ICU. Nevertheless, the consulted literature indicates that while it is easy to set the right amount of nutrient requirements among healthy people, the same does not apply when it comes to the critically ill patients. Stress, immune suppression, and other factors equally complicate the process of identifying the most optimal nutrient level requirements among patients. Nutritional therapy among patients in the ICU equally significantly differs between the European Society for Parenteral and Enteral Nutrition (ESPEN). There is always a challenge when it comes to the determining of when to commence Nutrient therapy.
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Methods
Rugeles et al. (2013) have adopted systematic methods of assessing the phenomena under study. The study was carried out at 30 beds ICU in a tertiary level university hospital in Colombia. The patients were recruited within a 12 months period. The study population constituted of individuals over the 18 years of age who were admitted to the ICU. These are patients who required enteral nutrition through a nasoenteric tube for a total of 96 hours. Patients who had previously received additional nutrient were excluded from the study. Randomization was carried out through the use of dark sealed envelopes. Only those patients who agreed to 96hours of follow up were considered during analyses. Statistical analyses were carried out through the use of TAMAMU software. It is worth noting that the study benefited from the merits associated with sampling method of data collection. For instance, the study was based on extensive data. It was difficult to gather information relating to all the patients in ICU in such hospitals, and hence the use of sampling method made the study easier.
Findings
There were no differences in SOFA score between the two groups under study. Initially, the intervention group showed in improvement in SOFA score after 48 hours. Enteral hyperproteic hypocaloric nutrition therapy was noted to decrease rates of multiple organ failures as measured via SOFA score. The intervention equally resulted in a reduced period of stay in the ICU, decreased hyperglycemia as well as trends towards less mechanical ventilation. Adequate provision of nutrients to patients in the ICU was thus noted top be critical in boosting the overall level of patient health outcome.
Primary article 2
The article has been established by Charles et al. (2014). The article has focused on the appropriate caloric goal of patients who are critically ill. The authors noted that it is still unclear on the caloric goal of such patients. In particular, the study assessed the effect of restricting nonprotein calories as compared to standard enteral feeding. 90-day mortality rates were assessed among the sample members under study.
Literature
In the study, the authors reviewed the literature extensively in such as a guide to the assessment. In literature, the authors noted that the caloric restriction had indicated prolonging of lifespan among many species through the promotion of mammalian cell survival. Lower levels of morbidity have been noted with hypocaloric nutrition than with the standard nutritional support. Caloric restriction was noted to be only effective when the right level of dietary proteins is provided to the patient.
Study design
The scholars assessed the permissive feeding versus the targeted enteral feeding among patients who are critically ill. The study was carried out in seven tertiary institutions in Saudi Arabia. Informed consent was collected from all of the involved participants ensuring that ethical code in data collection for research purposes was observed.
Some interventions were carried out in the study. The enrolled patients were assigned randommannerly to the permissive and underfeeding group. This was done through the use of opaque and sealed envelopes. The random numbers were computer generated. The feeding strategy was not blinded due to the need to adjust the nutritional support depending on the level of feeding tolerance as well as gastric residual volumes. In the permissive underfeeding group, the caloric goal was 40% to 60%. On the other hand, to the standard feeding group, the caloric group was 70% to 100%. In the study, the data was collected regarding the patient demographics, history of diabetes, acute physiology and admission category. Sequential organ failure assessment (SOFA) was also carried out during the study. During the intervention, data were collected regarding the total calories, calories from the enteral feeding, intravenous dextrose, and parenteral nutrition.
Findings
From the study, the initial outcome was 90day all-cause mortality. Serial sofa scores were collected. Some of the data gathered at this stage included the days that patients were free from mechanical ventilation. In any of the specified groups, there were no significant differences in mortality between the subgroups. From the study, the strategy where the enteral feeding was carried out on patients who received between 40 and 60% of the estimated calory requirements, and the recommended amount of proteins showed no significant effect on their mortality level s as compared to who had received 70 to 100% of the calories. Permissive underfeeding caused reduced blood glucose levels, insulin requirements were also reduced. The study nevertheless indicated that standard feeding goals do not improve clinical outcomes in the patients who are critically ill in the intensive care unit. The outcome of the study was nevertheless not noted to attenuate protein catabolism in patients who are critically ill. The study assessed whether caloric intake matters in some sub-populations. A controlled trial involving 82 patients suffering from post-traumatic brain disorder indicated better neurologic outcomes when the level of caloric outcomes was increased. Permissive underfeeding, when compared with standard feeding had no differential. It is worth noting that in the study, a fixed time limit was assigned to the tasks that were executed. As a result, it was not possible to identify the prevalence of the phenomena under study in the contexts of individualized care. It is thus important for further assessments to be carried out on the issue.
Conclusion
From the above studies, it is evident that the issue of nutrient intake among patients in the ICU and the impact of such calories in the push for the desired goals and objectives is a sensitive matter. The scholars have presented varying findings that indicate that the issue cannot be generalized on all conditions among people in the ICU. The issue of nutrient and caloric intake is dependent on the conditions that the patients are suffering from. In some cases, the intervention did not enhance the attainment of the desired health outcomes. In others, there was an improvement in patient health wellbeing and outcomes. At the same time, the study was conducted during fixed periods and did not thus consider the differential response of patients to the time they respond to intervention. From the study, it is clear that nutritional requirements are necessary for the support of the basic body functions of individuals who are in the ICU. Nevertheless, such nutrients have not indicated increased recovery among such patients since some of the issues that have led to patients being admitted in the ICU has nothing to do with the diet.
References
Arabi, Y. Et al. (2015). Permissive underfeeding or standard enteral feeding in critically ill adults. The New England Journal of Medicine, 372(25), 2398-2408
Charles, E. et al. (2014). Hypocaloric compared with eucoloric nutritional support and its effect on infection rates in a surgical intensive care unit: A randomized controlled trial. AM J Clin Nutr, 100 (1), 1337-1343
Rugeles, s.J. et al. (2013). Hyperproteic hypocaloric enteral nutrition in the critically ill patient: A randomized controlled clinical trial. Indian Journal of Critical Care Medicine 17(6), 344-349
Wischmeyer, P. (2015). Ensuring optimal survival and post ICU quality of life in high-risk ICU patients: permissive underfeeding is not safe. Crit Care Med , 43(8), 1769-1772
