Practice guidelines for nutrition in critically Ill patients: A relook for indian scenario

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Sanghamitra Chakravarti
2. Sunil Garg
3. Tanmay Banerjee
4. Ganesh Kadhe
5. Anshu Joshi
6. J.D. Sunavala
ISSN
0972-5229
DOI
10.4103/ijccm.IJCCM_3_18
Volume
22
Issue
4
Publishing Year
2018
Pages
11
Author Affiliations
    1. Department of Critical Care Medicine, Jaslok Hospital, Mumbai, Maharashtra, India
    1. Department of Nutrition and Dietetics, Medica Superspeciality Hospital, Kolkata, West Bengal, India
    1. Department of Intensive Care Medicine, Medica Institute of Critical Care, Medica Super speciality Hospital, Kolkata, West Bengal, India
    1. Department of Scientific and Medical Affairs, Abbott Nutrition International, ANI-, Mumbai, Maharashtra, India
    1. Department of Scientific and Medical Affairs, Abbott Nutrition International, ANI-, Mumbai, Maharashtra, India
  • Article keywords
    Critically ill patients, enteral nutrition, guidelines, scientific formula, tube feeding

    Abstract

    Background and Aim: Intensive-care practices and settings may differ for India in comparison to other countries. While international guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to Indian settings. Advisory board meetings were arranged to develop the practice guidelines specific to Indian context, for the use of EN in critically ill patients and to overcome challenges in this field. Methods: Various existing guidelines, meta-analyses, randomized controlled trials, controlled trials, and review articles were reviewed for their contextual relevance and strength. A systematic grading of practice guidelines by advisory board was done based on strength of the supporting evidence. Wherever Indian studies were not available, references were taken from the international guidelines. Results: Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding EN versus parenteral nutrition; nutrition screening and assessment; nutrition in hemodynamically unstable; route of nutrition; tube feeding and challenges; tolerance; optimum calorie-protein requirements; selection of appropriate enteral feeding formula; micronutrients and immune-nutrients; standard nutrition in hepatic, renal, and respiratory diseases and documentation of nutrition practices. Conclusion: This paper summarizes the optimum nutrition practices for critically ill patients. The possible solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance in critical care settings regarding appropriate critical-care nutrition practices and to set up Intensive Care Unit nutrition protocols.

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