Pragmatic approach to nutrition in the ICU: Expert opinion regarding which calorie protein target

BACKGROUND & AIMS:Since the publications of the ESPEN guidelines on enteral and parenteral nutrition in ICU, numerous studies have added information to assist the nutritional management of critically ill patients regarding the recognition of the right population to feed, the energy-protein targeting, the route and the timing to start. METHODS: We reviewed and discussed the literature related to nutrition in the ICU from 2006 until October 2013. RESULTS: To identify safe, minimal and maximal amounts for the different nutrients and at the different stages of the acute illness is necessary. These amounts might be specific for different phases in the time course of the patient's illness. The best approach is to target the energy goal defined by indirect calorimetry. High protein intake (1.5 g/kg/d) is recommended during the early phase of the ICU stay, regardless of the simultaneous calorie intake. This recommendation can reduce catabolism. Later on, high protein intake remains recommended, likely combined with a sufficient amount of energy to avoid proteolysis. CONCLUSIONS: Pragmatic recommendations are proposed to practically optimize nutritional therapy based on recent publications. However, on some issues, there is insufficient evidence to make expert recommendations

High-order nonlinearities in the motion of a trapped atom

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Same Governance, Different Day: Does Metropolitan Reorganization Make a Difference?

This commentary focuses on three points related to the debate about urban governmental restructuring: existing conflicts in the literature regarding the outcomes of local government consolidation; insights about consolidation based on an assessment of the amalgamation of twelve municipal units creating the new city of Ottawa; and, a discussion of a variety of methodological and political factors that may well account for the continuing inconsistency in academic assessments of structural change in local government. One possible explanation for the latter conflict is that governmental reorganization does not really make things substantially different in terms of taxes and services, that is, those outcomes most directly experienced by the average citizen. Over the long term other forces, such as intergovernmental relations and the economy, will tend to negate most of the initial effects of change. While there are likely to be winners and losers related to power in government or regime, it will be argued that in large part, for most citizens, governmental reorganization produces the same governance on a different day. Copyright 2004 by The Policy Studies Association..