12/12/2023 0 Comments First lipid emulsion therapy used![]() Parenteral nutrition (PN) is therefore recommended under certain circumstances (Table 1). ![]() EN may be contraindicated in patients with anatomic gastrointestinal disorders, severe diarrhea, and reduced intestinal blood flow. For example, EN may be frequently interrupted because of diagnostic investigations, surgery, diarrhea, vomiting, mechanical problems (e.g., tube displacement) or patient transfers. However, within the ICU setting EN may not be feasible or cannot be established at rates that provide adequate nutrition for a number of reasons. Current guidelines recommend that all ICU patients who tolerate enteral nutrition (EN) should receive EN (approximately 25–30 kcal/kg per day) if they are not expected to be on a full oral diet within 3 days. Given the association between negative energy balance/malnutrition and both morbidity and mortality, ensuring that critically ill patients receive adequate caloric and nutrient intake should be a high priority for intensive care clinicians. ![]() This article aims to review well-known papers that evaluate potential biologic effects of lipids when provided as a parenteral energy source and to provide future perspectives on the use of parenteral lipid emulsions (LEs) in critically ill patients. Delayed initiation of feeding and/or negative energy balance in critical care patients may also be associated with higher ICU and in-hospital mortality rates, while early initiation of feeding results in improved caloric intake. In addition, cumulative total energy deficit has been correlated with increased length of mechanical ventilation, length of ICU stay, total number of complications, and duration of antibiotic use. In two separate studies, progressive negative energy balance was strongly correlated with increased numbers of infectious complications, particularly sepsis. Prolonged negative energy balance within the ICU is associated with serious complications. Indeed, a number of studies have demonstrated that target caloric intake is achieved in only 50–75% of ICU patients and that as many as 25% of patients receive only 1,000–1,500 kcal/day. Multiple factors contribute to energy deficit, including increased metabolism, delays in the initiation of feeding, and inadequate caloric provision. This energy deficit often progresses during their ICU stay and may result in malnutrition and adverse outcomes. Many critically ill patients admitted to the intensive care unit (ICU) enter a state of negative energy balance during the first 3–4 days following admission. Prescription of PN containing LEs should be based on available clinical data, while considering the individual patient’s physiologic profile and therapeutic requirements. Ongoing research using adequately designed and well-controlled studies that characterize the biologic properties of LEs should assist clinicians in selecting LEs within the critical care setting. However, the effects of these LEs on clinical outcomes have not been extensively evaluated. Many of these LEs have demonstrated reduced effects on oxidative stress, immune responses, and inflammation. More recently developed parenteral LEs employ partial substitution of soybean oil with oils providing medium-chain triglycerides, ω-9 monounsaturated fatty acids or ω-3 PUFA. However, they may be associated with increased rates of infection and lipid peroxidation, which can exacerbate oxidative stress. Soybean-oil-based LEs with high contents of polyunsaturated fatty acids (PUFA) were the first widely used formulations in the intensive care setting. In this article, we review the role of parenteral lipid emulsions (LEs) in the management of critically ill patients and highlight important biologic activities associated with lipids. Lipids provide a key source of calories within PN formulations, preventing or correcting energy deficits and improving outcomes. Parenteral nutrition (PN), either alone or in combination with enteral nutrition, can improve nutrient delivery to critically ill patients. ![]() Energy deficit is a common and serious problem in intensive care units and is associated with increased rates of complications, length of stay, and mortality. ![]()
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