Clinical review: Optimizing enteral nutrition for critically ill patients--a simple data-driven formula.
Abstract
In modern critical care, the paradigm of 'therapeutic nutrition' is replacing traditional
'supportive nutrition'. Standard enteral formulas meet basic macro- and micronutrient
needs; therapeutic enteral formulas meet these basic needs and also contain specific
pharmaconutrients that may attenuate hyperinflammatory responses, enhance the immune
responses to infection, or improve gastrointestinal tolerance. Choosing the right
enteral feeding formula may positively affect a patient's outcome; targeted use of
therapeutic formulas can reduce the incidence of infectious complications, shorten
lengths of stay in the ICU and in the hospital, and lower risk for mortality. In this
paper, we review principles of how to feed (enteral, parenteral, or both) and when
to feed (early versus delayed start) patients who are critically ill. We discuss what
to feed these patients in the context of specific pharmaconutrients in specialized
feeding formulations, that is, arginine, glutamine, antioxidants, certain ω-3 and
ω-6 fatty acids, hydrolyzed proteins, and medium-chain triglycerides. We summarize
current expert guidelines for nutrition in patients with critical illness, and we
present specific clinical evidence on the use of enteral formulas supplemented with
anti-inflammatory or immune-modulating nutrients, and gastrointestinal tolerance-promoting
nutritional formulas. Finally, we introduce an algorithm to help bedside clinicians
make data-driven feeding decisions for patients with critical illness.
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Journal articlePermalink
https://hdl.handle.net/10161/12992Published Version (Please cite this version)
10.1186/cc10430Publication Info
Hegazi, Refaat A; & Wischmeyer, Paul E (2011). Clinical review: Optimizing enteral nutrition for critically ill patients--a simple
data-driven formula. Crit Care, 15(6). pp. 234. 10.1186/cc10430. Retrieved from https://hdl.handle.net/10161/12992.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Paul Edmund Wischmeyer
Professor of Anesthesiology
Paul Wischmeyer M.D., EDIC, FASPEN, FCCM is a critical care, perioperative, and nutrition
physician-researcher who specializes in enhancing preparation and recovery from surgery,
critical care and COVID-19. He serves as a Tenured Professor of Anesthesiology and
Surgery at Duke. He also serves as the Associate Vice Chair for Clinical Research
in the Dept. of Anesthesiology and Director of the TPN/Nutrition Team at Duke. Dr.
Wischmeyer earned his medical degree with honors at T

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