Nutrition Support for the Critically Ill PDF
4.54 MB PDF
Preface
Nutrition is complex by its nature. Daily, we ingest hundreds of substances, comprising literally thousands of chemical entities. And yet, our bodies—plus our gut microflora, as we know now—sort these out and create homeostasis. But with all of our science and our history, we still have only a hazy idea of which nutrients are beneficial, which harmful, and how much of either should be in our diet. Worse, we change our collective minds from year to year. And that is just in normal people. Illness makes nutrition even more complex.
Patients with illnesses often use nutrients differently, or respond differently to particular nutrients. This is especially true of critically ill patients. In these most seriously ill patients, the homeostasis of so many metabolic systems goes into varying degrees of disarray. Too often, the gastrointestinal tract itself is dysfunctional. The so-called nutritional measurements such as calorie expenditure, protein utilization, and serum micronutrient and protein levels often fail to instruct us well on how we should approach nourishing our patients. The manifestations of malnourishment and the dysmetabolism of disease may be indistinguishable. It should be no surprise that the nutritional research that drives our recommendations for addressing the needs of this extraordinarily diverse patient population falls far short. All too often, we have little certainty concerning when, where, what, how much, and for how long we should feed our patients.
This book is based on evidence-based practice (EBP). But… there is significant misunderstanding about just what EBP is. When most residents of fellows are asked to describe the quality or quantity of evidence required for evidence-based practice, invariably the answer is that data from prospective, randomized studies is required. But EBP, in fact, requires no evidence whatsoever. The proper definition of EBP is practice based on guidelines in which the quality of the evidence has been graded. The lowest level of quality in any guideline is that which is driven solely by expert opinion, without data. But this may be all we have to support our approach to patients. As with any common terminology, meaning shifts, or is lost, as it is taken for granted.
But a sad truth about nutrition is that evidence is too often anecdotal, inadequate, or just not there. In this text, we have set out to provide the practitioner with the scientific underpinnings of these complex issues. We have tried to make the best of the evidence that we have. We have maintained as much transparency as possible when facts are weak or not present. Which is all too frequently true. We have tried to avoid the usual pitfall of opinion presented as fact. Our hope is that this approach will better prepare practitioners in the intensive care unit to evaluate not only their patients but also the advice they receive from guidelines and other professionals. Most of all, we hope to promote flexibility. No dogma lasts forever. Time-honored practices may become obsolete, or proven ineffective, or even found to be harmful as better evidence emerges and as the context of care surrounding these practices changes.
There are many textbooks and guides that will give specific guidelines for practice. We have tried to avoid this as a primary goal and suggest the reader become familiar with sources for evidencebased guidelines that are kept current. In this day and age of rapid access and constant updating, a textbook such as this is not an appropriate source for how to practice. Rather, it should be a guideline to how to think about the problems of nourishing our patients.
If you found this book helpful then please like, subscribe and share.
Disclaimer:
This site complies with DMCA Digital Copyright Laws.Please bear in mind that we do not own copyrights to this book / software. We’re sharing this with our audience ONLY for educational purpose and we highly encourage our visitors to purchase original licensed software / Books. If someone with copyrights wants us to remove this software/Book, please contact us immediately.
You may send an email to myarslanlibrary@gmail.com for all DMCA/Removal Requests.
