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[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): cardiac patient].

Abstract
Patients with cardiac disease can develop two types of malnutrition: cardiac cachexia, which appears in chronic congestive heart failure, and malnutrition due to the complications of cardiac surgery or any other type of surgery in patients with heart disease. Early enteral nutrition should be attempted if the oral route cannot be used. When cardiac function is severely compromised, enteral nutrition is feasible, but supplementation with parenteral nutrition is sometimes required. Sustained hyperglycemia in the first 24 hours in patients admitted for acute coronary syndrome, whether diabetic or not, is a poor prognostic factor for 30-day mortality. In critically-ill cardiac patients with stable hemodynamic failure, nutritional support of 20-25 kcal/kg/day is effective in maintaining adequate nutritional status. Protein intake should be 1.2*-1.5 g/kg/day. Routine polymeric or high protein formulae should be used, according to the patient's prior nutritional status, with sodium and volume restriction according to the patient's clinical situation. The major energy source for myocytes is glutamine, through conversion to glutamate, which also protects the myocardial cell from ischemia in critical situations. Administration of 1 g/ day of omega-3 (EPA+DHA) in the form of fish oil can prevent sudden death in the treatment of acute coronary syndrome and can also help to reduce hospital admission for cardiovascular events in patients with chronic heart failure.
AuthorsF J Jiménez Jiménez, M Cervera Montes, A L Blesa Malpica, Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE)
JournalMedicina intensiva (Med Intensiva) Vol. 35 Suppl 1 Pg. 81-5 (Nov 2011) ISSN: 1578-6749 [Electronic] Spain
Vernacular TitleRecomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: paciente cardíaco.
PMID22309760 (Publication Type: Consensus Development Conference, English Abstract, Journal Article, Practice Guideline)
CopyrightCopyright © 2011 Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias (SEMICYUC) and Elsevier España, S.L. All rights reserved.
Chemical References
  • Dietary Proteins
  • Fatty Acids, Omega-3
  • Glutamine
Topics
  • Acute Coronary Syndrome (drug therapy)
  • Cachexia (etiology, prevention & control, therapy)
  • Cardiac Surgical Procedures
  • Critical Care (methods)
  • Critical Illness (therapy)
  • Death, Sudden, Cardiac (prevention & control)
  • Diet, Sodium-Restricted
  • Dietary Proteins (administration & dosage)
  • Energy Metabolism
  • Enteral Nutrition (methods, standards)
  • Fatty Acids, Omega-3 (administration & dosage, therapeutic use)
  • Food, Formulated
  • Glutamine (administration & dosage, therapeutic use)
  • Heart Diseases (complications, metabolism, therapy)
  • Humans
  • Malnutrition (etiology, prevention & control, therapy)
  • Myocytes, Cardiac (metabolism)
  • Parenteral Nutrition (methods, standards)
  • Postoperative Complications (etiology, prevention & control, therapy)
  • Societies, Medical (standards)
  • Societies, Scientific (standards)
  • Spain

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