★ Nutrition as a key treatment modality for clinical improvement in critically ill patients, neonates and hemodialysis patients

Nutrition for any patient is a fundamental aspect of the comprehensive treatment of his pathology, since it has a significant impact on his recovery and prognosis. In hospital settings, there are certain groups of patients who require special attention from a nutritional point of view. These are, for example, critically ill patients, newborns or those undergoing hemodialysis treatment.

In the first case, healthcare professionals involved in the care of patients in intensive care units must have the necessary knowledge about nutritional therapy, available therapeutic options and the recommendations of clinical guidelines. This is the purpose of the course Supplemental nutrition in the intensive care unit, Grupo Saned in collaboration with Baxter, which, among other things, considers indirect calorimetry as a diagnostic and therapeutic tool in clinical practice. It’s about technology ‘Gold standard’ to determine the nutritional needs of critically ill patients according to the 2023 ESPEN guidelines.¹

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In accordance with Dr. Maria Luisa Bordeje Laguna, Assistant Physician of the Intensive Care Medicine Service at the German Hospital Trias i Pujol and coordinator of this training, “The technology used to artificially feed critically ill patients will allow us to personalize treatment. All patients are not the same and, in addition, they go through evolutionary stages in which their nutritional needs change. Indirect calorimetry helps us determine the contribution of nutrients and avoid treatment errors due to both excess and defects.”

This diagnostic test determines oxygen consumption, carbon dioxide production and all related metabolic parameters.². Thus, it is performed to assess the patient’s energy needs and determine nutritional support.³. In this scenario, “nutrition is not support or care, but treatment. And so it needs to be dynamically adjusted because it can affect the patient’s clinical outcomes,” says Dr. Bordeget.

Complications that may increase comorbidities in hemodialysis patients

Metabolic disturbances present in chronic kidney disease (CKD) increase skeletal muscle catabolism and reduce muscle regeneration. Likewise, together these complications define energy protein depletion (EPD), a common syndrome in patients with CKD and predominantly on hemodialysis, leading to simultaneous loss of protein and energy⁴.

For Dr. Guillermina Barrilcourse coordinator Parenteral nutrition during intradialysis“In a broad sense, the development of protein-energy wastage can increase morbidity and mortality. For example, it leads to loss of muscle mass and fat due to proteolysis and loss of muscle mass, which affects functionality and increases the risk of falls, and in older people increases dependency.”

In all of these cases, experts emphasize the importance of ongoing education for health care providers involved in the care of these patients. Dr. Barril explains that during the latest course developed on intradialytic parenteral nutrition, “we shared knowledge and were able to improve clinical practice through an interdisciplinary approach. The fact that it was theoretical and practical gave a fuller vision and improved the discussion forum.”

Nutrition of newborns – one of the most vulnerable groups of patients

In a hospital setting, one of the most vulnerable groups of patients is newborns, and the course is dedicated to them. Standardized parenteral nutrition in neonatologywhich aims to improve the nutrition of premature infants in neonatal intensive care units and their follow-up after discharge.

For his coordinator Dr. Gerardo Rodriguez, Head of the Department of Neonatology and Perinatal Medicine of the Pediatric Service of the Lozano Blesa University Clinical Hospital in Zaragoza, “one of the fundamental pillars of the management of premature infants is the aspect of nutrition. Nutrition attempts to continue supplying nutrients from the prenatal period until after the newborn is born. Progress has been made in terms of early establishment of nutrition, with progress becoming more rapid in each of the immediate principles, not only in parenteral nutrition, but also in enteral nutrition.”

References:

1. Espen’s recommendations | Volume 42, Issue 9, pp. 1671-1689, September 2023 DOI: https://doi.org/10.1016/j.clnu.2023.07.011

2. Gupta R.D. et al. Indian J Endocrinol Metabl. 2017;21(4): 594–599;

3. Oshima T et al. Clinical Nutrition 2017;36:651–662.

4. 20 questions and 20 answers on parenteral nutrition during intradialysis. Interdisciplinary Working Group on Nutrition in Kidney Diseases of the Spanish Society of Nephrology (SENyNERC) and the Spanish Society of Nephrology Nurses (SEDEN).

Fountain: Dare