[Malnutrition and intensive care: discussion on a difficult case]

Area of Science:

• Critical Care Medicine
• Clinical Nutrition
• Metabolic Support

Background:

• Hospital malnutrition poses significant risks, leading to complications in critically ill patients.
• Critically ill patients often experience hypermetabolism, increasing nutritional needs and the risk of underfeeding.
• Nutritional support failure can contribute to adverse outcomes, including death from surgical and infectious complications.

Observation:

• A case report details a patient's 22-day intensive care unit (ICU) stay with failed nutritional support, resulting in death.
• The patient experienced surgical and infectious complications attributed to inadequate nutritional management.
• Challenges in achieving energy targets with exclusive enteral nutrition were noted.

Findings:

• Optimal nutritional support involves early metabolic interventions (glucose-insulin-potassium, antioxidants) and timely enteral nutrition (days 3-4).
• Combining enteral and parenteral nutrition may be necessary if enteral feeding alone fails to meet energy requirements within 5-6 days.
• Transitioning to oral feeding requires careful management, potentially using oral supplements or overnight enteral feeding to meet 50-75% of energy needs.

Implications:

• Effective nutritional management in ICUs requires diligent monitoring of daily and cumulative energy balance.
• Early and comprehensive nutritional strategies are vital for improving patient outcomes in critical care settings.
• Addressing underfeeding during and after critical illness is essential for preventing complications and mortality.