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Trophic or full nutritional support?
Yaseen M Arabi1,2,3, Hasan M Al-Dorzi1,2,3
1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences.
Current Opinion in Critical Care
|June 8, 2018
Summary
Full nutritional support in critical illness may not always be best. Permissive underfeeding shows similar outcomes to full feeding, especially in high-risk patients.
Area of Science:
- Critical care medicine
- Clinical nutrition
- Metabolic response to injury
Background:
- Traditional approach: full nutritional support in acute critical illness to prevent catabolism and malnutrition.
- Methods include early initiation, rapid target achievement, and supplemental parenteral nutrition if enteral intake is insufficient.
Purpose of the Study:
- To review current evidence on nutritional support strategies in acute critical illness.
- To evaluate the efficacy and safety of different feeding approaches.
Main Methods:
- Review of existing evidence and recent randomized controlled trials.
- Comparison of early enteral nutrition, delayed nutrition, parenteral nutrition, full feeding, permissive underfeeding, and trophic feeding.
Main Results:
- Early enteral nutrition is generally favored over delayed or early parenteral nutrition.
- Permissive underfeeding or trophic feeding demonstrates similar outcomes to full feeding in the acute phase.
- Aggressive full nutritional targets may worsen outcomes in specific populations (refeeding syndrome, high nutritional risk, shock).
Conclusions:
- A two-phase nutritional support approach may better align with critical illness physiology.
- Further research is needed on optimal protein intake and feeding strategies for high-risk patients or those with gastrointestinal injury.
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