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Use of high protein/low calories enteral nutrition in the ICU | Nestlé Health Science
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Interviewer: It's good.

Speaker 2: Thank you [unintelligible 00:00:01]

Interviewer: If it's ready. Good day, Juan. Nice to see you.

Juan: Nice to see you too.

Interviewer: We're coming out of the symposia, which was a great talk, thank you very much.

Juan: Thank you.

Interviewer: Really good to see you, and I would like ask you. Now that we have new products, I would like to know how do you use these high protein, hypocaloric products on your daily practice, in your ICU, and what benefits do you see in your patients?

Juan: I have changed my practice quite radically now that we have a formula that better adapts to the necessities, to the needs of the critically ill patients. I have essentially eliminated standard formulas because they provide too many calories and not enough protein. I have moved into then giving a lot more protein and significantly less calories with a high protein hypocaloric diet. I also use immune nutrition in my practice, but I only use it in the elective surgical patients after they come from the operating room.

Interviewer: Those high protein low calories you use only for the initial phase, or catabolic phase, or you use it for a longer period of time?

Juan: I start as early as possible, but I go gradually up in the first seven days. Depending on the patient, because I have a significant population that is morbidly obese, I may continue this hypocaloric high protein nutrition up to a month or more depending on the patient. In those patients, because we don't have a lot of data after seven days, in those patients I am very careful and I monitor them very, very carefully. They normally will go into having a little bit of ketones, and they are measurable, but I will monitor their nitrogen balance and monitor their wound healing, and their rehabilitation, their physical activity, as a way of monitoring muscle preservation and protein preservation.

Interviewer: Maybe just very short, what are the specific benefits that you've seen over time?

Juan: I see several very clear benefits. I see a metabolic benefit. I see a better balanced carbohydrate metabolism. That is immediate. The other benefit that I am observing is that my patients are not as hypermetabolic as they are with the conventional formula. It appears, and this is anecdotal, it appears that I can get them easier off the ventilator, that my patients are not as stressed as when I give them isocaloric low protein formulas.

Interviewer: Now knowing what you're doing, what do you think we still need to do in terms of research? Are there any gaps or product that you would like to see on your patients?

Juan: Absolutely. There's a large number of gaps. I want to follow patients long term, see if we fill the gap, after the first seven days what happens. The other thing that I want to do is I want to know specific nutrients and how we're going to giving them. Specific amino acids, how we should be giving them. We should study many other things including the benefit or not of carbohydrates. I would love to do some work on that. The sky is the limit. We need laboratory data. We need numbers. We need objective laboratory data.

[00:04:02] [END OF AUDIO]

Video // ESICM 2019


Professor Juan Ochoa Gautier

ESICM 2019