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Gressies C, Schuetz P. Nutritional issues concerning general medical ward patients: feeding patients recovering from critical illness. Curr Opin Clin Nutr Metab Care 2023; 26:138-145. [PMID: 36730133 DOI: 10.1097/mco.0000000000000894] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW ICU survivors often spend long periods of time in general wards following transfer from ICU in which they are still nutritionally compromised. This brief review will focus on the feeding of patients recovering from critical illness, as no formal recommendations or guidelines on nutrition management are available for this specific situation. RECENT FINDINGS While feeding should start in the ICU, it is important to continue and adapt nutritional plans on the ward to support individuals recovering from critical illness. This process is highly complex - suboptimal feeding may contribute significantly to higher morbidity and mortality, and seriously hinder recovery from illness. Recently, consensus diagnostic criteria for malnutrition have been defined and large-scale trials have advanced our understanding of the pathophysiological pathways underlying malnutrition. They have also helped further develop treatment algorithms. However, we must continue to identify specific clinical parameters and blood biomarkers to further personalize therapy for malnourished patients. Better understanding of such factors may help us adapt nutritional plans more efficiently. SUMMARY Adequate nutrition is a vigorous component of treatment in the post-ICU period and can enhance recovery and improve clinical outcome. To better personalize nutritional treatment because not every patient benefits from support in the same manner, it is important to further investigate biomarkers with a possible prognostic value.
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Affiliation(s)
- Carla Gressies
- Division of General Internal and Emergency Medicine, Medical University Department, Cantonal Hospital Aarau, Aarau
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, Medical University Department, Cantonal Hospital Aarau, Aarau
- University of Basel, Basel, Switzerland
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Gundogan K, Yucesoy FS, Ozer NT, Temel S, Sahin S, Sahin GG, Sungur M, Esmaoglu A, Talih T, Yazici C, Griffith DP, Ziegler TR. Serum Micronutrient Levels in Critically III Patients Receiving Continuous Renal Replacement Therapy: A Prospective, Observational Study. JPEN J Parenter Enteral Nutr 2022; 46:1141-1148. [PMID: 35383966 DOI: 10.1002/jpen.2378] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/04/2022] [Accepted: 03/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) may deplete micronutrient levels. Patients are also at risk for micronutrient depletion due to underlying illness(s), poor nutrient intake prior to intensive care unit (ICU) admission and/or increased requirements. We determined vitamin and trace element status before, during and after CRRT in critically ill patients. METHODS This prospective observational study performed in mixed medical and surgical ICU patients. Serial serum vitamin B6 and vitamin C concentrations were measured by HPLC and folic acid by ECLIA. Serum chromium, copper, selenium, and zinc were measured using ICP-MS. Serum ceruloplasmin was measured by the Erel method. RESULTS Fifty adult ICU patients with AKI were recruited. The median APACHE II score on ICU admission was high at 24.0 (6.0-33.0). The median days on CRRT was 2.0 (2.0-4.0) days. At baseline (within 10-15 minutes of CRRT initiation), serum vitamin C, selenium and zinc were below normal. Serum vitamin B6 levels at 72 hours on CRRT were significantly lower than at 24 hours (p=0.011). Serum vitamin C values fell significantly at 24 and 72 hours during CRRT (p=0.030 and p=0.001), respectively, and remained low 24 and 48 hours after CRRT was stopped (p=0.021). At baseline and during CRRT, 96% of participants had at least two or more micronutrient levels below the normal range. CONCLUSION Serum vitamin C, selenium and zinc concentrations were below the normal range at baseline. CRRT was associated with a significant further decrease in levels of vitamin C, selenium and zinc. CLINICAL RELEVANCY STATEMENT Critically ill patients who were experienced CRRT had serum vitamin C, selenium and zinc below the normal range during and after CRRT. Also, 96% of participants had at least two or more micronutrient levels below normal at baseline and during CRRT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kursat Gundogan
- Department of Internal Medicine, Division of Intensive Care, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Faruk S Yucesoy
- Department of Anesthesiology and Reanimation, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Nurhayat T Ozer
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | - Sahin Temel
- Department of Internal Medicine, Division of Intensive Care, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Serap Sahin
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | - Gulsah G Sahin
- Division of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkey
| | - Murat Sungur
- Department of Internal Medicine, Division of Intensive Care, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Aliye Esmaoglu
- Department of Anesthesiology and Reanimation, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Tutkun Talih
- Department of General Surgery, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Cevat Yazici
- Department of Clinical Biochemistry, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Daniel P Griffith
- Department of Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA.,Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Herrera-Quintana L, Vázquez-Lorente H, Molina-López J, Gamarra-Morales Y, Planells E. Selenium Levels and Antioxidant Activity in Critically Ill Patients with Systemic Inflammatory Response Syndrome. Metabolites 2022; 12:metabo12040274. [PMID: 35448461 PMCID: PMC9025155 DOI: 10.3390/metabo12040274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
The Selenium (Se) status could be an important modifiable factor in critically ill patient outcomes due to the important role of this mineral in several functions. Although there are many clinical trials with Se interventions in the literature, the evidence is not sufficient to establish a common criterion regarding the Se status. Background and aims: An analysis was made of the evolution of selenium (Se) and antioxidant status in critically ill patients with Systemic Inflammatory Response Syndrome (SIRS) over 7 days of staying in the Intensive Care Unit (ICU). Methods: A prospective analytical study was carried out on 65 critically ill patients aged 31−77 years. A healthy control group of 56 volunteers from the same region was recruited to allow comparisons with reference normal values. The selenium levels in both the plasma and erythrocytes were analyzed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Glutathione Peroxidase (GPx) and Superoxide Dismutase (SOD) activity and the Total Antioxidant Capacity (TAC) were measured using kinetic colorimetric methods. Results: Low erythrocyte and plasma Se levels were found at ICU admission in comparison with the healthy reference group (p < 0.001), and the levels further decreased after one week (p < 0.001). Smaller changes in the plasma Se levels were associated with greater changes in the Sequential Organ Failure Assessment (SOFA) score (p < 0.05). The GPx activity in the critically ill was lower than in the control group (p < 0.05), with an inverse correlation to the severity scores at the baseline (p < 0.05) and reaching normal values after one week (p < 0.05). SOD activity was directly correlated to TAC (p = 0.03), with both parameters exhibiting a direct correlation to albumin (p < 0.05) after 7 days of ICU stay. Conclusions: A deficient Se status was observed at ICU admission and worsened further over follow-up regardless of the evolution of the patient severity and the antioxidant parameters. Adequate Se support from the start of admission could preserve and contribute to improve the Se-related outcomes and critical patient recovery during longer periods in the ICU.
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Affiliation(s)
- Lourdes Herrera-Quintana
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (Y.G.-M.)
| | - Héctor Vázquez-Lorente
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (Y.G.-M.)
| | - Jorge Molina-López
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (Y.G.-M.)
- Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain
- Correspondence: (J.M.-L.); (E.P.)
| | - Yenifer Gamarra-Morales
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (Y.G.-M.)
| | - Elena Planells
- Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.); (Y.G.-M.)
- Correspondence: (J.M.-L.); (E.P.)
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