Archive | 2019
Common Controversies in Critical Care Nutrition: Review of Latest Evidences
Abstract
Context\u2003Critical care nutrition favorably influences patient prognosis and remains an essential component of overall patient care. Various guidelines and literature discuss the modalities, benefits, and other finer details of nutrition in intensive care units. Critical care nutrition is still an emerging modality and hence, ambiguity/subjectivity exists in various aspects. Clear recommendations are not there, especially when it comes to diverse topics such as nutrition screening/assessment, underfeeding patients, types of nutrition formulae, monitoring nutrition adequacy, and tolerance and likewise. This article is an attempt to address couple of these concerns and review the latest evidences/guidelines in context of nutrition screening/assessment and monitoring tolerance by measuring gastric residual volumes (GRVs). Evidence Acquisition\u2003Various literature including existing guidelines, original articles, and review articles published till September 2019 and discussing the specifics of nutrition screening/assessment and monitoring tolerance by measuring gastric residuals were searched on popular scientific databases such as PubMed, Scholar Google, and Embase and reviewed for contextual relevance. Results\u2003Majority of the recommendations/evidences in this regard are either inconsistent or incomplete. Most of the tools that are recommended for nutrition screening/assessment of critical care patients are not validated for this population. Majority of literature is unanimous on not recommending biochemical parameters to be used for this purpose. Recommendations for the acceptable values of GRVs are consistent but subjectivity exits on the frequency of measurement, timing of measurement in relation to meals, and other variables. Conclusion\u2003Till the time, nutrition screening/assessment tools for critical care patients are validated in large multicentric settings, it would be prudent to adhere to the recommendations of existing guidelines. Similarly, GRV practices and cutoff values can be followed from relevant guidelines.