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Considering energy deficit in the intensive care unit
Pierre Singer1, Claude Pichard, Claudia P Heidegger
1Department of General Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. psinger@clalit.org.il
Current Opinion in Clinical Nutrition and Metabolic Care
|December 19, 2009
Summary
Experts disagree on parenteral nutrition for ICU patients. Guidelines from ASPEN/SCCM and ESPEN differ on supplementing enteral nutrition, impacting patient outcomes and highlighting the need for further research.
Area of Science:
- Critical Care Medicine
- Nutritional Support
- Clinical Guidelines
Background:
- Discrepancies exist in expert recommendations for feeding ICU patients when enteral nutrition targets are unmet.
- Parenteral nutrition (PN) is considered when enteral nutrition (EN) is insufficient, but optimal strategies vary.
Purpose of the Study:
- To review and compare recent guidelines from the American Society of Parenteral and Enteral Nutrition (ASPEN) and the European Society of Clinical Nutrition and Metabolism (ESPEN) on nutritional support in ICUs.
- To highlight differences in recommendations regarding the use of PN to meet nutritional requirements in critically ill patients.
Main Methods:
- Comparative analysis of recent ASPEN/SCCM and ESPEN guidelines.
- Review of observational studies correlating energy balance with morbidity and mortality in ICU patients.
Main Results:
- ASPEN/SCCM guidelines suggest caution in administering PN to non-malnourished ICU patients receiving partial EN within the first 7-10 days.
- ESPEN guidelines recommend supplementing with PN to compensate for deficits within 24-48 hours.
- Observational data link negative energy balance to increased morbidity and mortality.
Conclusions:
- Accumulated energy deficits in underfed ICU patients may significantly affect outcomes, particularly for long-stay patients.
- The optimal approach to artificial nutritional support to meet calorie requirements without causing harm remains a subject of ongoing debate.
- Future research is anticipated to provide clearer guidance on this critical aspect of intensive care nutrition.
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