Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: obese patient.

Mar 14, 2012Nutricion hospitalaria

Updated Nutritional and Metabolic Support Guidelines for Critically Ill Obese Patients

AI simplified

Abstract

Obese critically-ill patients may have a similar risk of nutritional deficiency as non-obese patients.

Both obese and non-obese critically-ill patients can develop protein-energy malnutrition and experience accelerated muscle mass loss.
Nutritional support aims to minimize lean mass loss and accurately assess energy needs.
Using actual weight in calorie requirements can lead to overestimation; adjusted or ideal weight is recommended.
Hypocaloric nutrition may reduce infectious complications and improve hyperglycemia control in these patients.
Standard recommendations suggest providing 60-70% of caloric requirements, with specific protein intake guidelines.
Current evidence lacks prospective randomized trials specifically for obese critically-ill patients, necessitating cautious interpretation.

AI simplified

As a response to metabolic stress, obese critically-ill patients have the same risk of nutritional deficiency as the non-obese and can develop protein-energy malnutrition with accelerated loss of muscle mass. The primary aim of nutritional support in these patients should be to minimize loss of lean mass and accurately evaluate energy expenditure. However, routinely used formulae can overestimate calorie requirements if the patient's actual weight is used. Consequently, the use of adjusted or ideal weight is recommended with these formulae, although indirect calorimetry is the method of choice. Controversy surrounds the question of whether a strict nutritional support criterion, adjusted to the patient's requirements, should be applied or whether a certain degree of hyponutrition should be allowed. Current evidence suggested that hypocaloric nutrition can improve results, partly due to a lower rate of infectious complications and better control of hyperglycemia. Therefore, hypocaloric and hyperproteic nutrition, whether enteral or parenteral, should be standard practice in the nutritional support of critically-ill obese patients when not contraindicated. Widely accepted recommendations consist of no more than 60-70% of requirements or administration of 11-14 kcal/kg current body weight/day or 22-25 kcal/kg ideal weight/day, with 2-2.5 g/kg ideal weight/day of proteins. In a broad sense, hypocaloric-hyperprotein regimens can be considered specific to obese critically-ill patients, although the complications related to comorbidities in these patients may require other therapeutic possibilities to be considered, with specific nutrients for hyperglycemia, acute respiratory distress syndrome (ARDS) and sepsis. However, there are no prospective randomized trials with this type of nutrition in this specific population subgroup and the available data are drawn from the general population of critically-ill patients. Consequently, caution should be exercised when interpreting these data.

Abstract

Related papers

what lands in your inbox each week: