Making a Difference - Nutritional Support in Critically Ill Patients

Introduction

For many years, the major controversy surrounding critical care nutrition was in fact “do critically ill patients actually need nutrition?” In years past (and perhaps even today) provision of nutrition to such patients typically received a very low priority. This problem was later described as “in-hospital starvation” and is most common in the care of elderly human patients (1). When the effects of malnutrition on patient morbidity and mortality were realized, a reactive movement ensued in critical care in the 1970's which coincided with the development and adoption of parenteral nutrition; many patients were fed quite aggressively, leading to the term “hyperalimentation”. It was later determined that such an approach, whereby patients received calories well in excess of their needs, led to its own set of complications (2,3). Much like other aspects of critical care, our paradigm of critical care nutrition constantly changes; previously held assumptions become less relevant and new research uncovers novel strategies.

Nutritional support is now considered essential for the recovery of post-operative, critically ill, and injured human patients. Whilst there is convincing evidence of the deleterious effects of malnutrition in people (4,5) the optimal nutritional strategies for critically ill and post-operative animals remain controversial and are largely unknown (Figure 1). Because malnutrition imparts similar metabolic effects in animals, it is assumed that nutritional support is equally essential for the recovery of critically ill dogs and cats. Although definitive answers regarding the impact of nutritional support on outcome in critically ill animals are lacking, some encouraging results suggest that outcome in hospitalized animals can be enhanced with nutritional support (6-8). From these emerging advancements in veterinary nutrition, and our current understanding of metabolic response to injury, we are beginning to formulate recommendations for the nutritional management of critically ill animals. In fact, with proper patient selection, sound nutritional planning, and careful monitoring, nutritional support can be an integral part in the successful recovery of many critically ill animals. [...]

Key Points

• Nutritional support can be an integral part in the successful recovery of many critically ill animals.

• The optimal nutritional strategies for critically ill and post-operative animals remain controversial and are largely unknown.

• Nutrition via a functional digestive system is always the preferred route of feeding.

• First steps in instituting nutritional support include restoring proper hydration status, correcting electrolyte or acid-base disturbances, and achieving hemodynamic stability.