December 2004

Caring for the Critically Ill Morbidly Obese Patient
Ali El-Solh, MD, MPH

1. Hedley AA, Ogden CL, Johnson CL, et al: Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 2004; 291: 2847–2850.

2. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Executive Summary. National Institutes of Health, September 1998. http://www.nhlbi.nih.gov.guidelines/obesity/ob_gdlns.htm.

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4. El-Solh A, Sikka P, Bozkanat E, et al: Morbid obesity in the medical ICU. Chest 2001; 120: 1989–1997.

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6. Gupta RM, Parvizi J, Hanssen, AD, Gay PC: Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc 76: 897–905.

7. Cutts ME, Dowdy RP, Ellersieck MR, Edes TE: Predicting energy needs in ventilator-dependent critically ill patients: effect of adjusting weight for edema or adiposity. Am J Clin Nutr 1997; 66:1250–1256.

8. Ireton-Jones C, Francis C: Obesity: nutrition support practice and application to critical care. Nutr Clin Pract 1995; 10:144–149.

9. Brown G, Dodeck P: Intravenous insulin nomogram improves blood glucose control in the critically ill. Crit Care Med 2001; 29:1714–1719.

10. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in the critically ill patients. N Engl J Med 2001; 345:1359–1367.

11. Argenta L, Morykwas M: Vacuum-assistive closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997; 38: 563–577.

12. Rees RS, Robson MC, Smiell JM, Perry BH: Becaplermin gel in the treatment of pressure ulcers: a phase II randomized, double-blind, placebo-controlled study. Wound Repair Regen 1999; 7:141–147.

The Critical Care Dietitian--the “Other” Professional
Beth E. Taylor, MS, RD, LD, CNSD, FCCM

1. American Society for Parenteral and Enteral Nutrition Board of Directors and Task Force on Standards for Specialized Nutrition Support for Hospitalized Adult Patients, Russell M, Andres M, Brewer C: Standards for Specialized Nutrition Support: Adult Hospitalized Patients. Nutr Clin Pract 2002; 12:384–391.

2. Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P: Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 2003; 27:355–373.

3. Alberda C, Snowden L, McCargar L, Gramlich: Energy requirements in critically ill patients: How close are our estimates? Nutr Clin Pract 2002; 17:38–42.

4. Breen H, Ireton-Jones C: Predicting energy needs in obese patients. Nutr Clin Pract 2004; 19:284–289.

5. Johansen NN, Kondrup J, Plum LM, Bak L, Norregaard P, Bunch E, et al: Effect of nutritional support on clinical outcome in patients at nutritional risk. Clin Nutr 2004; 23:539–550.

6. Malone A. The clinical benefits and efficacy of using specialized enteral feeding formulas. Support Line 2002; 24:3–9.

7. Malone A: Methods of assess energy expenditure in the intensive care unit. Nutr Clin Pract 2002; 17:21–28.

8. McKibbin B, Cresci G, Hawkins M: Nutrition support for the patient with an open abdomen after major abdominal trauma. Nutrition 2003; 19:563–566.

9. Taylor BE, Huey WY, Buchman TG, Boyle WA, Coopersmith CM: Treatment of hypophosphatemia using a protocol based on patient weight and serum phosphorus level in a surgical intensive care unit. J Am Coll Surg 2004; 198:198–204.

10. Taylor B, Huey W, Buchman TG: Clinical effectiveness of a nurse-driven insulin infusion protocol in the surgical ICU. Crit Care Med 2004; 31 (Supple S):A62.

11. Taylor B, Everett S, Muckova N: Blind bedside small bowel feeding tube placement in 1220 critically ill patients—a success story. Crit Care Med 2003; 31:A85.

12. Slagt C, Innes R, Bihari D, Lawrence J, Shehabi Y: A novel method for insertion of postpyloric feeding tubes at the bedside without endoscopic or fluoroscopic assistance: a prospective study. Intensive Care Med 2004; 30:103–107.

13. Stone SJ, Pickett JD, Jesurum JT: Bedside placement of postpyloric feeding tubes. AACN Clin Issues 2000; 11:517–30.

14. Powers J, Chance R, Bortenschlager L, Hottenstein J, Bobel K, Gervasio J, et al: Bedside placement of small-bowel feeding tubes in the intensive care unit. Crit Care Nurse 2003; 23:16–24.

15. Ochoa J, Magnuson B, Swintowsky M: Long-term reduction in cost of nutritional intervention achieved by a nutrition support service. Nutr Clin Pract 2000; 15:174–180.

16. Goldstein M, Braitman LE, Levine GM: The medical and financial costs associated with termination of a nutrition support nurse. JPEN J Parenter Enteral Nutr 2000; 24:323–7.

Rationale for Underfeeding the Critically Ill Patient
John E. Mazuski, MD, PhD

1. Chiolero R, Revelly JP, Tappy L: Energy metabolism in sepsis and injury. Nutrition 1997; 13:45S–51S.

2. McClave SA, Lowen CC, Kleber, et al: Are patients fed appropriately according to their caloric requirements? JPEN J Parenter Enteral Nutr 1998; 22:375–381.

3. Klein S, Kinney J, Jeejeebhoy K, et al: Nutrition support in clinical practice: Review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. JPEN J Parenter Enteral Nutr 1997; 21:133–156.

4. Moore FA, Feliciano DV, Andrassy RJ, et al: Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 1992; 216:172–183.

5. Dickerson RN, Boschert KJ, Kudsk KA, Brown RO: Hypocaloric enteral tube feeding in critically ill obese patients. Nutrition 2002; 18:241–246.

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7. Choban PS, Burge JC, Scales D, Flancbaum L: Hypoenergetic nutrition support in hospitalized obese patients: A simplified method for clinical application. Am J Clin Nutr 1997; 66:546–550.

8. Frankenfield DC, Smith JS, Cooney RN: Accelerated nitrogen loss after traumatic injury is not attenuated by achievement of energy balance. JPEN J Parenter Enteral Nutr 1997; 21:324–329.

9. Battistella FD, Widergren JT, Anderson JT, et al: A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition. J Trauma 1997; 43:52–58.

10. McCowen KC, Friel C, Sternberg J, et al: Hypocaloric total parenteral nutrition: effectiveness in prevention of hyperglycemia and infectious complications—a randomized clinical trial. Crit Care Med 2000; 28:3606–3611.

Proven Strategies for Keeping a Team on Track
Jay S. Cowen, MD; Joanne M. Lindberg, MN, RN, CCRN; Thomas G. Rainey, MD, FCCM

1. Institute of Medicine: Health Professional Education: A Bridge to Quality. Washington, DC, National Academies Press, 2003.

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3. Kudsk, KA, Tolley EA, DeWitt RC, Janu PG, Blackwell AP, Yeary S, King BK: Preoperative albumin and surgical site identify surgical risk for major postoperative complications. JPEN J Parenter Enteral Nutr 2003; 27:1–9.

4. Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM: Surgical site infections: reanalysis of risk factors. J Surg Res 2002; 103:89–95.

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8. Bassili HR, Deitel M: Effect of nutritional support on weaning patients off mechanical ventilators. JPEN J Parenter Enteral Nutr 1981; 5:161–163.

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13. Mee-Nin Kan, Han-Hsin Chang, Woei-Fen Sheu, Chien-Hsiang Cheng, Bor-Jen Lee, Yi-Chia Huang: Estimation of energy requirements for mechanically ventilated, critically ill patients using nutritional status. The Critical Care Forum 2003; 7:R108–R115.

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40. Hwang T-L, Huang S-L, Chen M-F: The use of indirect calorimetry in critically ill patients: The relationship of measured energy expenditure to injury severity score, septic severity score, and APACHE II score. J Trauma 1993; 34:247–251.

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