J Neuroanaesth Crit Care 2015; 02(02): 88-96
DOI: 10.4103/2348-0548.154228
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Nutrition in the neurocritical care unit

Swagata Tripathy
1   Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Sijua, Bhubaneswar, Odisha, India
› Author Affiliations

Subject Editor:
Further Information

Publication History

Publication Date:
02 May 2018 (online)

Abstract

The aim of intensive care is to support the physiology of the body till the treatment or the reparative process of the body kicks in to the rescue. Maintaining an adequate nutrition during this period is of vital importance to counteract the catabolic effect of the critical disease process. The guidelines for nutritional care in the neuro intensive care unit (ICU) are sparse. This article collates the current evidence and best practice recommendations as applicable to the critically ill patient in the neuro ICU. The use of screening tests to identify patients at a risk of malnutrition and related complications is presently recommended for all patients with an emphasis on early initiation of caloric support. Over-aggressive feeding in an attempt to revert the catabolic effects of critical illness have not proven beneficial, just as the attempts to improve patient outcomes by altering the routes of nutrition administration. Special patient population such as traumatic brain injury, stroke, subarachnoid haemorrhage or spinal cord injury may have varying nutritional requirements; individualised approach in the neurocritical ICU with the help of the intensivist, nutritionist and pharmacology team may be of benefit.

 
  • REFERENCES

  • 1 Casaer MP, Van den Berghe G. Nutrition in the acute phase of critical illness. N Engl J Med 2014; 370: 2450-1
  • 2 Tripathy S, Mishra JC, Dash SC. Critically ill elderly patients in a developing world--mortality and functional outcome at 1 year: A prospective single-center study. J Crit Care 2014; 29: 474.e7-13
  • 3 Barr J, Hecht M, Flavin KE, Khorana A, Gould MK. Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest 2004; 125: 1446-57
  • 4 Hollander JM, Mechanick JI. Nutrition support and the chronic critical illness syndrome. Nutr Clin Pract 2006; 21: 587-604
  • 5 Boniatti MM, Friedman G, Castilho RK, Vieira SR, Fialkow L. Characteristics of chronically critically ill patients: Comparing two definitions. Clinics (Sao Paulo) 2011; 66: 701-4
  • 6 Cuthbertson D, Tilstone WJ. Metabolism during the post injury period. Adv Clin Chem 1969; 12: 1-55
  • 7 Badjatia N. Nutrition and Metabolism. Neurocritical Care Society Practice Update. Available from: http://www.neurocriticalcare.org/sites/default/files/pdfs/07.Nutrition.final.pdf [Last accessed on 2015 Jan 20].
  • 8 Wischmeyer PE. The evolution of nutrition in critical care: How much, how soon?. Crit Care 2013; 17: S7
  • 9 Coltman A, Peterson S, Roehl K, Roosevelt H, Sowa D. Use of 3 tools to assess nutrition risk in the intensive care unit. JPEN J Parenter Enteral Nutr. 2014
  • 10 Preiser JC. Do we need an assessment of the nutrition risk in the critically ill patient. Crit Care 2012; 16: 101
  • 11 Tripathy S. Which screening tool in elderly critically ill patients?. Available from: http://www.esicm2go.org/libraryEntry/show/413694995491040349 [Last accessed on 2015 Jan 14].
  • 12 Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: The development and initial validation of a novel risk assessment tool. Crit Care 2011; 15: R268
  • 13 McClave SA, Martindale RG, Kiraly L. The use of indirect calorimetry in the intensive care unit. Curr Opin Clin Nutr Metab Care 2013; 16: 202-8
  • 14 Neelemaat F, van Bokhorst-de van der Schueren MA, Thijs A, Seidell JC, Weijs PJ. Resting energy expenditure in malnourished older patients at hospital admission and three months after discharge: Predictive equations versus measurements. Clin Nutr 2012; 31: 958-66
  • 15 Mehta NM, Bechard LJ, Dolan M, Ariagno K, Jiang H, Duggan C. Energy imbalance and the risk of overfeeding in critically ill children. Pediatr Crit Care Med 2011; 12: 398-405
  • 16 Kee AL, Isenring E, Hickman I, Vivanti A. Resting energy expenditure of morbidly obese patients using indirect calorimetry: A systematic review. Obes Rev 2012; 13: 753-65
  • 17 Tripathy S, Mishra P, Dash SC. Refeeding syndrome. Indian J Crit Care Med 2008; 12: 132-5
  • 18 Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux RN, Delarue J. et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 2005; 24: 502-9
  • 19 Dvir D, Cohen J, Singer P. Computerized energy balance and complications in critically ill patients: An observational study. Clin Nutr 2006; 25: 37-44
  • 20 Rice TW, Mogan S, Hays MA, Bernard GR, Jensen GL, Wheeler AP. Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. Crit Care Med 2011; 39: 967-74
  • 21 Arabi YM, Tamim HM, Dhar GS, Al-Dawood A, Al-Sultan M, Sakkijha MH. et al. Permissive underfeeding and intensive insulin therapy in critically ill patients: A randomized controlled trial. Am J Clin Nutr 2011; 93: 569-77
  • 22 Schetz M, Casaer MP, Van den Berghe G. Does artificial nutrition improve outcome of critical illness?. Crit Care 2013; 17: 302
  • 23 Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G. et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011; 365: 506-17
  • 24 NICE-SUGAR Study Investigators. Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V. et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360: 1283-97
  • 25 Kramer AH, Roberts DJ, Zygun DA. Optimal glycemic control in neurocritical care patients: A systematic review and meta-analysis. Crit Care 2012; 16: R203
  • 26 McCormick M, Hadley D, McLean JR, Macfarlane JA, Condon B, Muir KW. Randomized, controlled trial of insulin for acute post stroke hyperglycemia. Ann Neurol 2010; 67: 570-8
  • 27 Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients?. A systematic review of the literature. Nutrition 2004; 20: 843-8
  • 28 Simpson F, Doig GS. Parenteral vs. enteral nutrition in the critically ill patient: A meta-analysis of trials using the intention to treat principle. Intensive Care Med 2005; 31: 12-23
  • 29 Desai SV, McClave SA, Rice TW. Nutrition in the ICU: An evidence-based approach. Chest 2014; 145: 1148-57
  • 30 Doig GS, Heighes PT, Simpson F, Sweetman EA. Early enteral nutrition reduces mortality in trauma patients requiring intensive care: A meta-analysis of randomised controlled trials. Injury 2011; 42: 50-6
  • 31 Doig GS, Simpson F, Sweetman EA, Finfer SR, Cooper DJ, Heighes PT. et al. Early PN Investigators of the ANZICS Clinical Trials Group. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: A randomized controlled trial. JAMA 2013; 309: 2130-8
  • 32 Baroni AF, Fábio SR, Dantas RO. Risk factors for swallowing dysfunction in stroke patients. Arq Gastroenterol 2012; 49: 118-24
  • 33 Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Stroke Practice Improvement Network Investigators. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005; 36: 1972-6
  • 34 Westergren A. Detection of eating difficulties after stroke: A systematic review. Int Nurs Rev 2006; 53: 143-9
  • 35 Okubo PC, Fábio SR, Domenis DR, Takayanagui OM. Using the National Institute of Health Stroke Scale to predict dysphagia in acute ischemic stroke. Cerebrovasc Dis 2012; 33: 501-7
  • 36 Davies AR, Morrison SS, Bailey MJ, Bellomo R, Cooper DJ, Doig GS. et al. ENTERIC Study Investigators, ANZICS Clinical Trials Group. A multicenter, randomized controlled trial comparing early nasojejunal with nasogastric nutrition in critical illness. Crit Care Med 2012; 40: 2342-8
  • 37 Koc D, Gercek A, Gencosmanoglu R, Tozun N. Percutaneous endoscopic gastrostomy in the neurosurgical intensive care unit: Complications and outcome. JPEN J Parenter Enteral Nutr 2007; 31: 517-20
  • 38 Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F. et al. Clinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: A randomized controlled trial. JAMA 2013; 309: 249-56
  • 39 Polidori MC, Mecocci P, Frei B. Plasma vitamin C levels are decreased and correlated with brain damage in patients with intracranial hemorrhage or head trauma. Stroke 2001; 32: 898-902
  • 40 Hannity KA, Selim MH. Antioxidant strategies in neurocritical care. Neurotherapeutics 2012; 9: 44-55
  • 41 Curtis CS, Kudsk KA. Do immunonutrients improve outcomesin the critically ill? In Evidence based practise of critical care. Vol 2. Chapter 67. Deutschman CS, Neligan PJ. editors. Saunders Elsevier; Philadelphia, USA: 2010
  • 42 Chan LN. Nutritional support in acute renal failure. Curr Opin Clin Nutr Metab Care 2004; 7: 207-12
  • 43 Singer P, Theilla M, Fisher H, Gibstein L, Grozovski E, Cohen J. Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med 2006; 34: 1033-8
  • 44 Badjatia N, Vespa P. And the Participants of the International Multi-disciplinary Consensus Conference on Multimodality Monitoring. Monitoring nutrition and glucose in acute brain injury. Neurocrit Care. 2014
  • 45 Härtl R, Gerber LM, Ni Q, Ghajar J. Effect of early nutrition on deaths due to severe traumatic brain injury. J Neurosurg 2008; 109: 50-6
  • 46 White H, Venkatesh B. Clinical review: Ketones and brain injury. Crit Care 2011; 15: 219
  • 47 Ritter AM, Robertson CS, Goodman JC, Contant CF, Grossman RG. Evaluation of a carbohydrate-free diet for patients with severe head injury. J Neurotrauma 1996; 13: 473-85
  • 48 Young B, Ott L, Kasarskis E, Rapp R, Moles K, Dempsey RJ. et al. Zinc supplementation is associated with improved neurologic recovery rate and visceral protein levels of patients with severe closed head injury. J Neurotrauma 1996; 13: 25-34
  • 49 Cope EC, Morris DR, Scrimgeour AG, Levenson CW. Use of zinc as a treatment for traumatic brain injury in the rat: Effects on cognitive and behavioral outcomes. Neurorehabil Neural Repair 2012; 26: 907-13
  • 50 Dennis MS, Lewis SC, Warlow C. FOOD Trial Collaboration. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): A multicentre randomised controlled trial. Lancet 2005; 365: 764-72
  • 51 Koukiasa P, Bitzani M, Papaioannou V, Pnevmatikos I. Resting energy expenditure in critically Ill patients with spontaneous intracranial hemorrhage (SICH). JPEN J Parenter Enteral Nutr. 2014
  • 52 Schmidt JM, Claassen J, Ko SB, Lantigua H, Presciutti M, Lee K. et al. Nutritional support and brain tissue glucose metabolism in poor-grade SAH: A retrospective observational study. Crit Care 2012; 16: R15
  • 53 Dionyssiotis Y. Malnutrition in spinal cord injury: More than nutritional deficiency. J Clin Med Res 2012; 4: 227-36
  • 54 Chalela JA. Pearls and pitfalls in the intensive care management of Guillain-Barre syndrome. Semin Neurol 2001; 21: 399-405
  • 55 Roubenoff RA, Borel CO, Hanley DF. Hypermetabolism and hypercatabolism in Guillain-Barre syndrome. JPEN J Parenter Enteral Nutr 1992; 16: 464-72
  • 56 Schulman RC, Mechanick JI. Metabolic and nutrition support in the chronic critical illness syndrome. Respir Care 2012; 57: 958-77
  • 57 Boateng AA, Sriram K, Meguid MM, Crook M. Refeeding syndrome: Treatment considerations based on collective analysis of literature case reports. Nutrition 2010; 26: 156-67
  • 58 Tripathy S, Nair P, Rothburn M. Clostridium difficile associated disease in a neurointensive care unit. Front Neurol 2013; 4: 82
  • 59 De Legge, Mark H, Berry A. Enteral feeding: Should it be continued in the patient with clostridium difficile enterocolitis?. Pract Gastroenterol. 2009: 40