Critical Care Focus, 7: Nutritional Issues
Helen F. Galley (ed)
BMJ Books: London, UK, 2002, 70 pp; illustrated; indexed
ISBN: 0-7279-1652-1; Price £14.95
The philosophy underlying the 'Critical Care Focus' series is to provide readers with topical and evidence-based overviews of key areas of intensive care. Each chapter is written by an expert in the field and based on a lecture delivered to the Intensive Care Society.
This volume attempts to address some of the controversies related to feeding in critically ill patients. The scene is set in the first chapter, where the importance of providing adequate nutrition is argued. The rest of the book builds on this information. Data are presented showing that malnutrition and low body mass index are independent predictors of mortality. The notion of mimicking physiological feeding is addressed; enteral feeding given intermittently rather than continuously. Parenteral nutrition is shown to be preferable to no nutrition, and in certain circumstances, such as head injuries, may offer advantages over enteral feeding. Important debates are confronted, including when to start feeding, how much to feed and how to avoid complications related to feeding. The latter sections are somewhat more controversial in that they cover such topics as immunonutrition, glutamine supplementation and micronutrients. To some extent, where evidence remains equivocal, the bias of the contributors is reflected. Overall, this book offers a topical and wide-ranging overview of nutritional issues. Not all intensivists would agree with the emphases and recommendations. However, this is healthy and will inspire debate and further research.
M. S. Avidan