Yoğun Bakımda Malnutrisyon Yönetimi
Özet
Yoğun bakım hastaları, büyük oranda hayati organ sistemlerinin akut bozulmasına bağlı olarak kritik durumdadır. Bu hasta grubunun özel ekipman ve yüksek eğitimli personelin olduğu yoğun bakım ünitelerinde tedavi edilmeleri gereklidir. Kritik hastalıklar, hızlanmış katabolizma ve hormonal değişikliklerle ilişkili metabolik yanıtı içerir. Bu hastalarda, izleme cihazları ve tüpler gibi karmaşık bakım gereksinimleri bulunur. Yoğun bakım hastalarında malnutrisyon oranı yüksektir ve bireysel olarak uyarlanmış tıbbi beslenme tedavisinin önemi vurgulanır. Tıbbi beslenme tedavisi çoğunlukla, erken enteral nütrisyonun başlatılması ve gerektiğinde parenteral nütrisyon ile birleştirilmesi şeklinde uygulanır. Refeeding sendromu riski yüksek hastalarda, özellikle kalori artışının yavaşça gerçekleştirilmesi önerilir. Malnutrisyon riski, klinik değerlendirme ve dolaylı kalorimetri ölçümleriyle belirlenir. Dolaylı kalorimetri, hastanın gerçek enerji ihtiyacını analiz edebilmek için önemli bir değerlendirme yöntemidir. Enerji, protein ve diğer besin öğeleriyle ilgili öneriler, hastanın hayati risklerini azaltmaya odaklanmalıdır. Özellikle, yoğun bakım gerektiren hastalıklar metabolik süreçlerle malnutrisyona neden olabilir. Malnutrisyonun takibi zordur ancak enerji ihtiyaçları belirlenmelidir. Yoğun bakımda tedavi gören hastalar, beslenme yetersizliği, glisemik kontrol sorunları ve reflekslerin takibi gibi karmaşık durumlarla karşı karşıyadır. Beslenme intoleransı yaşayan hastalarda, beslenme miktarı yavaşça artırılmalıdır. Tıbbi beslenme tedavisi, kritik hastaların bakımının önemli bir parçasıdır ve farklı sağlık otoritelerinin rehberlerinde uygulamalar farklılık gösterir. Hastaların özellikleri göz önünde bulundurularak bireysel beslenme stratejilerin belirlienmesi önerilmektedir.
Referanslar
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Blaser, A. R., Starkopf, J., & Malbrain, M. L. (2015). Abdominal signs and symptoms in intensive care patients. Anaesthesiology intensive therapy, 47(4), 379-387.
Bousie, E., Van Blokland, D., Lammers, H. J. W., & Van Zanten, A. R. H. (2016). Relevance of non-nutritional calories in mechanically ventilated critically ill patients. European journal of clinical nutrition, 70(12), 1443-1450.
Bruns, B. R., & Kozar, R. A. (2016). Feeding the postoperative patient on vasopressor support: Feeding and pressor support. Nutrition in Clinical Practice, 31(1), 14-17.
Burgos, R., Bretón, I., Cereda, E., Desport, J. C., Dziewas, R., Genton, L., & Bischoff, S. C. (2018). ESPEN guideline clinical nutrition in neurology. Clinical Nutrition, 37(1), 354-396.
Buttery, A. K., Busch, M. A., Gaertner, B., Scheidt-Nave, C., & Fuchs, J. (2015). Prevalence and correlates of frailty among older adults: findings from the German health interview and examination survey. BMC geriatrics, 15(1), 1-9.
Cederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., & GLIM Core Leadership Committee, GLIM Working Group. (2019). GLIM criteria for the diagnosis of malnutrition–a consensus report from the global clinical nutrition community. Journal of cachexia, sarcopenia and muscle, 10(1), 207-217.
Chapple, L. A. S., Summers, M. J., Bellomo, R., Chapman, M. J., Davies, A. R., Ferrie, S., & TARGET Investigator Collaborative and the ANZICS Clinical Trials Group. (2021). Use of a High‐Protein Enteral Nutrition Formula to Increase Protein Delivery to Critically Ill Patients: A Randomized, Blinded, Parallel‐Group, Feasibility Trial. Journal of Parenteral and Enteral Nutrition, 45(4), 699-709.
Charrière, M., Ridley, E., Hastings, J., Bianchet, O., Scheinkestel, C., & Berger, M. M. (2017). Propofol sedation substantially increases the caloric and lipid intake in critically ill patients. Nutrition, 42, 64-68.
CNSG East Cheshire NHS Trust: Guidelines for Prevention and Management of Refeeding Syndrome in Adults. 2015. Available online: https://docplayer.net/45404167-Guidelines- for-prevention-and-management-of-refeeding-syndrome-in-adults.htm (Erişim: 20.10.2023).
Davies, M. L., Chapple, L. A. S., Chapman, M. J., Moran, J. L., & Peake, S. L. (2017). Protein delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis. Critical care and resuscitation, 19(2), 117-127.
De Waele, E., Jonckheer, J., & Wischmeyer, P. E. (2021). Indirect calorimetry in critical illness: a new standard of care?. Current opinion in critical care, 27(4), 334-343.
Dresen, E., Weißbrich, C., Fimmers, R., Putensen, C., & Stehle, P. (2021). Medical high-protein nutrition therapy and loss of muscle mass in adult ICU patients: A randomized controlled trial. Clinical Nutrition, 40(4), 1562-1570.
Duan, J. Y., Zheng, W. H., Zhou, H., Xu, Y., & Huang, H. B. (2021). Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis. Critical Care, 25, 1-10.
Elke, G., Felbinger, T. W., & Heyland, D. K. (2015). Gastric residual volume in critically ill patients: a dead marker or still alive?. Nutrition in Clinical Practice, 30(1), 59-71.
Elke, G., Hartl, W.H., Kreymann, K.G., Adolph, M., Felbinger, T.W., Graf, T., de Heer, G., Heller, A.R., Kampa, U., Mayer, K., Muhl E., Niemann B., Rümelin A., Steiner S., Stoppe C., Weimann A., Bischoff S.C. (2019). Clinical Nutrition in Critical Care Medicine—Guideline of the German Society for Nutritional Medicine (DGEM). Clin. Nutr. ESPEN, (33) 220–275.
Engelman, D. T., Ali, W. B., Williams, J. B., Perrault, L. P., Reddy, V. S., Arora, R. C., & Boyle, E. M. (2019). Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA surgery, 154(8), 755-766.
Ferrie, S., Allman‐Farinelli, M., Daley, M., & Smith, K. (2016). Protein requirements in the critically ill: a randomized controlled trial using parenteral nutrition. Journal of Parenteral and Enteral Nutrition, 40(6), 795-805.
Fetterplace, K., Deane, A. M., Tierney, A., Beach, L. J., Knight, L. D., Presneill, J., & MacIsaac, C. (2018). Targeted full energy and protein delivery in critically ill patients: a pilot randomized controlled trial (FEED trial). Journal of Parenteral and Enteral Nutrition, 42(8), 1252- 1262.
Gentile, L. F., Cuenca, A. G., Efron, P. A., Ang, D., Bihorac, A., McKinley, B. A., & Moore, F. A. (2012). Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care. Journal of Trauma and Acute Care Surgery, 72(6), 1491- 1501.
Gunst, J., Vanhorebeek, I., Thiessen, S. E., & Van den Berghe, G. (2018). Amino acid supplements in critically ill patients. Pharmacological research, 130, 127-131.
Hartl, W. H., & Jauch, K. W. (2014). Metabolic self-destruction in critically ill patients: origins, mechanisms and therapeutic principles. Nutrition, 30(3), 261-267.
Heyland, D. K., Cahill, N. E., Dhaliwal, R., Sun, X., Day, A. G., & McClave, S. A. (2010). Impact of enteral feeding protocols on enteral nutrition delivery: results of a multicenter observational study. Journal of Parenteral and Enteral Nutrition, 34(6), 675-684.
Heyland, D. K., Patel, J., Bear, D., Sacks, G., Nixdorf, H., Dolan, J., & Compher, C. (2019). The effect of higher protein dosing in critically ill patients: a multicenter registry‐based randomized trial: the EFFORT trial. Journal of Parenteral and Enteral Nutrition, 43(3), 326-334.
Heyland, D. K., Stapleton, R., & Compher, C. (2018). Should we prescribe more protein to critically ill patients?. Nutrients, 10(4), 462.
Hill, A., Arora, R. C., Engelman, D. T., & Stoppe, C. (2020). Preoperative treatment of malnutrition and sarcopenia in cardiac surgery: new frontiers. Critical Care Clinics, 36(4), 593-616.
Hill, A., Goetzenich, A., Marx, G., & Stoppe, C. (2018). Role of Nutrition Support in Cardiac Surgery Patients-an Overview. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS, 53(6), 466-479.
Hill, A., Goetzenich, A., Marx, G., & Stoppe, C. (2018). Role of Nutrition Support in Cardiac Surgery Patients-an Overview. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS, 53(6), 466-479.
Hill, A., Heyland, D. K., Elke, G., Schaller, S. J., Stocker, R., Haberthür, C., Stoppe, C. (2020). Meeting nutritional targets of critically ill patients by combined enteral and parenteral nutrition: review and rationale for the EFFORTcombo trial. Nutrition Research Reviews, 33(2), 312-320.
Hill, A., Heyland, D. K., Ortiz Reyes, L. A., Laaf, E., Wendt, S., Elke, G., & Stoppe, C. (2022). Combination of enteral and parenteral nutrition in the acute phase of critical illness: an updated systematic review and meta‐analysis. Journal of Parenteral and Enteral Nutrition, 46(2), 395-410.
Hill, A., Nesterova, E., Lomivorotov, V., Efremov, S., Goetzenich, A., Benstoem, C., & Stoppe, C. (2018). Current evidence about nutrition support in cardiac surgery patients—what do we know?. Nutrients, 10(5), 597.
Kondrup, J. (2014). Nutritional-risk scoring systems in the intensive care unit. Current Opinion in Clinical Nutrition & Metabolic Care, 17(2), 177-182.
Kozeniecki, M., McAndrew, N., & Patel, J. J. (2016). Process‐related barriers to optimizing enteral nutrition in a tertiary medical intensive care unit. Nutrition in Clinical Practice, 31(1), 80-85.
Lambell, K. J., Tatucu-Babet, O. A., Chapple, L. A., Gantner, D., & Ridley, E. J. (2020). Nutrition therapy in critical illness: a review of the literature for clinicians. Critical Care, 24, 1-11.
Lambell, K.J., Tatucu-Babet, O.A., Chapple, L.A., Gantner, D., Ridley, E.J. (2020). Nutrition therapy in critical illness: A review of the literature for clinicians. Crit. Care (24) 1–11.
Lee, Z. Y., Yap, C. S. L., Hasan, M. S., Engkasan, J. P., Barakatun-Nisak, M. Y., Day, A. G., & Heyland, D. K. (2021). The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Critical Care, 25(1), 1-15.
Lew, C. C. H., Yandell, R., Fraser, R. J., Chua, A. P., Chong, M. F. F., & Miller, M. (2017). Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review. Journal of Parenteral and Enteral Nutrition, 41(5), 744-758.
Ljungqvist, O. (2014). ERAS—enhanced recovery after surgery: moving evidence‐based perioperative care to practice. Journal of Parenteral and Enteral Nutrition, 38(5), 559-566.
Mahan, K.L. & Raymond J.L. (2017). Krause’s Food & the Nutrition Care Process (14th ed). Elsevier.
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., Gervasio, J. M., Sacks, G. S., Roberts, P. R., Compher, C., Society of Critical Care Medicine, & American Society for Parenteral and Enteral Nutrition (2016). Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN. Journal of parenteral and enteral nutrition, 40(2), 159–211. https://doi.org/10.1177/0148607115621863
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Blaser, A. R., Starkopf, J., & Malbrain, M. L. (2015). Abdominal signs and symptoms in intensive care patients. Anaesthesiology intensive therapy, 47(4), 379-387.
Bousie, E., Van Blokland, D., Lammers, H. J. W., & Van Zanten, A. R. H. (2016). Relevance of non-nutritional calories in mechanically ventilated critically ill patients. European journal of clinical nutrition, 70(12), 1443-1450.
Bruns, B. R., & Kozar, R. A. (2016). Feeding the postoperative patient on vasopressor support: Feeding and pressor support. Nutrition in Clinical Practice, 31(1), 14-17.
Burgos, R., Bretón, I., Cereda, E., Desport, J. C., Dziewas, R., Genton, L., & Bischoff, S. C. (2018). ESPEN guideline clinical nutrition in neurology. Clinical Nutrition, 37(1), 354-396.
Buttery, A. K., Busch, M. A., Gaertner, B., Scheidt-Nave, C., & Fuchs, J. (2015). Prevalence and correlates of frailty among older adults: findings from the German health interview and examination survey. BMC geriatrics, 15(1), 1-9.
Cederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., & GLIM Core Leadership Committee, GLIM Working Group. (2019). GLIM criteria for the diagnosis of malnutrition–a consensus report from the global clinical nutrition community. Journal of cachexia, sarcopenia and muscle, 10(1), 207-217.
Chapple, L. A. S., Summers, M. J., Bellomo, R., Chapman, M. J., Davies, A. R., Ferrie, S., & TARGET Investigator Collaborative and the ANZICS Clinical Trials Group. (2021). Use of a High‐Protein Enteral Nutrition Formula to Increase Protein Delivery to Critically Ill Patients: A Randomized, Blinded, Parallel‐Group, Feasibility Trial. Journal of Parenteral and Enteral Nutrition, 45(4), 699-709.
Charrière, M., Ridley, E., Hastings, J., Bianchet, O., Scheinkestel, C., & Berger, M. M. (2017). Propofol sedation substantially increases the caloric and lipid intake in critically ill patients. Nutrition, 42, 64-68.
CNSG East Cheshire NHS Trust: Guidelines for Prevention and Management of Refeeding Syndrome in Adults. 2015. Available online: https://docplayer.net/45404167-Guidelines- for-prevention-and-management-of-refeeding-syndrome-in-adults.htm (Erişim: 20.10.2023).
Davies, M. L., Chapple, L. A. S., Chapman, M. J., Moran, J. L., & Peake, S. L. (2017). Protein delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis. Critical care and resuscitation, 19(2), 117-127.
De Waele, E., Jonckheer, J., & Wischmeyer, P. E. (2021). Indirect calorimetry in critical illness: a new standard of care?. Current opinion in critical care, 27(4), 334-343.
Dresen, E., Weißbrich, C., Fimmers, R., Putensen, C., & Stehle, P. (2021). Medical high-protein nutrition therapy and loss of muscle mass in adult ICU patients: A randomized controlled trial. Clinical Nutrition, 40(4), 1562-1570.
Duan, J. Y., Zheng, W. H., Zhou, H., Xu, Y., & Huang, H. B. (2021). Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis. Critical Care, 25, 1-10.
Elke, G., Felbinger, T. W., & Heyland, D. K. (2015). Gastric residual volume in critically ill patients: a dead marker or still alive?. Nutrition in Clinical Practice, 30(1), 59-71.
Elke, G., Hartl, W.H., Kreymann, K.G., Adolph, M., Felbinger, T.W., Graf, T., de Heer, G., Heller, A.R., Kampa, U., Mayer, K., Muhl E., Niemann B., Rümelin A., Steiner S., Stoppe C., Weimann A., Bischoff S.C. (2019). Clinical Nutrition in Critical Care Medicine—Guideline of the German Society for Nutritional Medicine (DGEM). Clin. Nutr. ESPEN, (33) 220–275.
Engelman, D. T., Ali, W. B., Williams, J. B., Perrault, L. P., Reddy, V. S., Arora, R. C., & Boyle, E. M. (2019). Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA surgery, 154(8), 755-766.
Ferrie, S., Allman‐Farinelli, M., Daley, M., & Smith, K. (2016). Protein requirements in the critically ill: a randomized controlled trial using parenteral nutrition. Journal of Parenteral and Enteral Nutrition, 40(6), 795-805.
Fetterplace, K., Deane, A. M., Tierney, A., Beach, L. J., Knight, L. D., Presneill, J., & MacIsaac, C. (2018). Targeted full energy and protein delivery in critically ill patients: a pilot randomized controlled trial (FEED trial). Journal of Parenteral and Enteral Nutrition, 42(8), 1252- 1262.
Gentile, L. F., Cuenca, A. G., Efron, P. A., Ang, D., Bihorac, A., McKinley, B. A., & Moore, F. A. (2012). Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care. Journal of Trauma and Acute Care Surgery, 72(6), 1491- 1501.
Gunst, J., Vanhorebeek, I., Thiessen, S. E., & Van den Berghe, G. (2018). Amino acid supplements in critically ill patients. Pharmacological research, 130, 127-131.
Hartl, W. H., & Jauch, K. W. (2014). Metabolic self-destruction in critically ill patients: origins, mechanisms and therapeutic principles. Nutrition, 30(3), 261-267.
Heyland, D. K., Cahill, N. E., Dhaliwal, R., Sun, X., Day, A. G., & McClave, S. A. (2010). Impact of enteral feeding protocols on enteral nutrition delivery: results of a multicenter observational study. Journal of Parenteral and Enteral Nutrition, 34(6), 675-684.
Heyland, D. K., Patel, J., Bear, D., Sacks, G., Nixdorf, H., Dolan, J., & Compher, C. (2019). The effect of higher protein dosing in critically ill patients: a multicenter registry‐based randomized trial: the EFFORT trial. Journal of Parenteral and Enteral Nutrition, 43(3), 326-334.
Heyland, D. K., Stapleton, R., & Compher, C. (2018). Should we prescribe more protein to critically ill patients?. Nutrients, 10(4), 462.
Hill, A., Arora, R. C., Engelman, D. T., & Stoppe, C. (2020). Preoperative treatment of malnutrition and sarcopenia in cardiac surgery: new frontiers. Critical Care Clinics, 36(4), 593-616.
Hill, A., Goetzenich, A., Marx, G., & Stoppe, C. (2018). Role of Nutrition Support in Cardiac Surgery Patients-an Overview. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS, 53(6), 466-479.
Hill, A., Goetzenich, A., Marx, G., & Stoppe, C. (2018). Role of Nutrition Support in Cardiac Surgery Patients-an Overview. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS, 53(6), 466-479.
Hill, A., Heyland, D. K., Elke, G., Schaller, S. J., Stocker, R., Haberthür, C., Stoppe, C. (2020). Meeting nutritional targets of critically ill patients by combined enteral and parenteral nutrition: review and rationale for the EFFORTcombo trial. Nutrition Research Reviews, 33(2), 312-320.
Hill, A., Heyland, D. K., Ortiz Reyes, L. A., Laaf, E., Wendt, S., Elke, G., & Stoppe, C. (2022). Combination of enteral and parenteral nutrition in the acute phase of critical illness: an updated systematic review and meta‐analysis. Journal of Parenteral and Enteral Nutrition, 46(2), 395-410.
Hill, A., Nesterova, E., Lomivorotov, V., Efremov, S., Goetzenich, A., Benstoem, C., & Stoppe, C. (2018). Current evidence about nutrition support in cardiac surgery patients—what do we know?. Nutrients, 10(5), 597.
Kondrup, J. (2014). Nutritional-risk scoring systems in the intensive care unit. Current Opinion in Clinical Nutrition & Metabolic Care, 17(2), 177-182.
Kozeniecki, M., McAndrew, N., & Patel, J. J. (2016). Process‐related barriers to optimizing enteral nutrition in a tertiary medical intensive care unit. Nutrition in Clinical Practice, 31(1), 80-85.
Lambell, K. J., Tatucu-Babet, O. A., Chapple, L. A., Gantner, D., & Ridley, E. J. (2020). Nutrition therapy in critical illness: a review of the literature for clinicians. Critical Care, 24, 1-11.
Lambell, K.J., Tatucu-Babet, O.A., Chapple, L.A., Gantner, D., Ridley, E.J. (2020). Nutrition therapy in critical illness: A review of the literature for clinicians. Crit. Care (24) 1–11.
Lee, Z. Y., Yap, C. S. L., Hasan, M. S., Engkasan, J. P., Barakatun-Nisak, M. Y., Day, A. G., & Heyland, D. K. (2021). The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Critical Care, 25(1), 1-15.
Lew, C. C. H., Yandell, R., Fraser, R. J., Chua, A. P., Chong, M. F. F., & Miller, M. (2017). Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review. Journal of Parenteral and Enteral Nutrition, 41(5), 744-758.
Ljungqvist, O. (2014). ERAS—enhanced recovery after surgery: moving evidence‐based perioperative care to practice. Journal of Parenteral and Enteral Nutrition, 38(5), 559-566.
Mahan, K.L. & Raymond J.L. (2017). Krause’s Food & the Nutrition Care Process (14th ed). Elsevier.
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., Gervasio, J. M., Sacks, G. S., Roberts, P. R., Compher, C., Society of Critical Care Medicine, & American Society for Parenteral and Enteral Nutrition (2016). Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN. Journal of parenteral and enteral nutrition, 40(2), 159–211. https://doi.org/10.1177/0148607115621863
Mooi, N. M., & Ncama, B. P. (2019). Evidence on nutritional therapy practice guidelines and implementation in adult critically ill patients: A systematic scoping review. Curationis, 42(1), 1-13.
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Sayfalar
71-82
Gelecek
21 Mart 2024
Telif Hakkı (c) 2024 Akademisyen Yayınevi Kitap Portalı
Lisans
LisansNasıl Atıf Yapılır
1.
Öztürk Altuncevahir İ. Yoğun Bakımda Malnutrisyon Yönetimi. Içinde: Eti Aslan F, Olgun N, editörler. Yoğun Bakım Seçilmiş Semptom Bulguların Yönetimi (3. BASKI) [Internet]. Türkiye: Akademisyen Yayınevi Kitap DOI Portalı; 2024 [a.yer 13 Temmuz 2026]. ss. 71-82. Erişim adresi: https://www.omp35.books.akademisyen.net/index.php/akya/catalog/book/3016/chapter/13738
