Nutrición parenteral suplementada en el final de la vida: consideraciones nutricionales y tecnológicas  <span class="so-article-trans-title" dir="auto"> Translated title: Supplemented parenteral nutrition at the end-of life: nutritional and technological considerations </span>

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Abstract

Resumen Introducción: El final de la vida (FV) implica un periodo en el cual una determinada enfermedad u otra situación conducen a un inexorable camino hacia la muerte. La situación clínica hace muy complejo el abordaje del FV, especialmente en aquellos estadios donde la vía parenteral constituye la única forma para proporcionar el soporte nutricional. Método: Se realizó una revisión bibliográfica narrativa basada en la búsqueda, en distintas bases de datos tales como Medline, Science Direct y Scopus, de todos los artículos publicados, hasta marzo de 2021, que muestran una serie de consideraciones nutricionales y tecnológicas de la nutrición parenteral (NP) suplementada y sus posibles beneficios en el FV. Resultados: Se hace necesario realizar una adecuada monitorización del FV con NP para determinar la importancia de adicionar suplementos nutricionales, por sus efectos beneficiosos, tales como glutamina, arginina, zinc, cromo, citrulina, selenio, zinc o coenzima Q para atenuar las alteraciones propias del FV y evitar nuevas complicaciones. También, deben considerarse una serie de criterios tecnológicos que garanticen la estabilidad de la NP y sus nutrientes. Conclusiones: La NP suplementada que se administra en el FV implica controlar una serie de factores que están implicados en su estabilidad. Se han observado acciones beneficiosas de NP suplementada con zinc, selenio, cromo y taurina.

Translated abstract

Abstract Introduction: The end of life (OL) implies a period in which a certain disease or other situation leads to an inexorable path towards death. The clinical situation makes the approach to VF very complex, especially in those stages where the parenteral route is the only way to provide nutritional support. Method: A narrative bibliographic review was carried out based on the search in different databases such as Medline, Science Direct and Scopus of all the articles published until March 2021 that show a series of nutritional and technological considerations of supplemented parenteral nutrition (PN) and your possible benefits at EOL. Results: It is necessary to carry out adequate monitoring of FV with PN to determine the importance of adding nutritional supplements, due to their beneficial effects, such as glutamine, arginine, zinc, chromium, citrulline, selenium, zinc or coenzyme Q to attenuate the alterations typical of FV and avoid new complications. Also, a series of technological criteria must be considered to guarantee the stability of the NP and its nutrients. Conclusions: The supplemented PN that is administered in the FV involves controlling a series of factors that are involved in its stability. Beneficial actions have been observed with NP supplemented with zinc, selenium, chromium and taurine.

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Is Open Access

Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients

Peter Weijs, Wilhelmus GPM Looijaard, Albertus Beishuizen … (2014)

Introduction Early protein and energy feeding in critically ill patients is heavily debated and early protein feeding hardly studied. Methods A prospective database with mixed medical-surgical critically ill patients with prolonged mechanical ventilation (>72 hours) and measured energy expenditure was used in this study. Logistic regression analysis was used to analyse the relation between admission day-4 protein intake group (with cutoffs 0.8, 1.0, and 1.2 g/kg), energy overfeeding (ratio energy intake/measured energy expenditure > 1.1), and admission diagnosis of sepsis with hospital mortality after adjustment for APACHE II (Acute Physiology and Chronic Health Evaluation II) score. Results A total of 843 patients were included. Of these, 117 had sepsis. Of the 736 non-septic patients 307 were overfed. Mean day-4 protein intake was 1.0 g/kg pre-admission weight per day and hospital mortality was 36%. In the total cohort, day-4 protein intake group (odds ratio (OR) 0.85; 95% confidence interval (CI) 0.73 to 0.99; P = 0.047), energy overfeeding (OR 1.62; 95%CI 1.07 to 2.44; P = 0.022), and sepsis (OR 1.77; 95%CI 1.18 to 2.65; P = 0.005) were independent risk factors for mortality besides APACHE II score. In patients with sepsis or energy overfeeding, day-4 protein intake was not associated with mortality. For non-septic, non-overfed patients (n = 419), mortality decreased with higher protein intake group: 37% for <0.8 g/kg, 35% for 0.8 to 1.0 g/kg, 27% for 1.0 to 1.2 g/kg, and 19% for ≥1.2 g/kg (P = 0.033). For these, a protein intake level of ≥1.2 g/kg was significantly associated with lower mortality (OR 0.42, 95%CI 0.21 to 0.83, P = 0.013). Conclusions In non-septic critically ill patients, early high protein intake was associated with lower mortality and early energy overfeeding with higher mortality. In septic patients early high protein intake had no beneficial effect on mortality. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0701-z) contains supplementary material, which is available to authorized users.