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How to Feed the Critically Ill-A Review.
Charles Ch Lew1, Chengsi Ong, Amartya Mukhopadhyay
1Dietetics and Nutrition Department, Ng Teng Fong General Hospital, Singapore.
Annals of the Academy of Medicine, Singapore
|November 9, 2020
Summary
Critically ill patients in the intensive care unit (ICU) require individualized nutrition support, with early enteral nutrition (EN) initiation and gradual achievement of energy and protein goals improving outcomes. Indirect calorimetry is recommended for accurate energy target setting.
Area of Science:
- Critical Care Medicine
- Clinical Nutrition
- Metabolic Support
Background:
- Recent studies have significantly altered clinical practices regarding nutritional support in intensive care units (ICUs).
- Evidence synthesis is crucial for updating guidelines and optimizing patient care in critical illness.
Purpose of the Study:
- To review the latest evidence on nutrition screening, body composition assessment, energy and protein targets, and delivery methods in ICUs.
- To compare recent guidelines and highlight differences in nutrition support approaches for critically ill patients.
Main Methods:
- Systematic review of recent studies on nutritional support in the ICU.
- Comparison of current guidelines with emerging evidence.
Main Results:
- All ICU patients with >48 hours stay are at nutrition risk and need individualized support, irrespective of initial status.
- Indirect calorimetry is recommended for accurate energy target setting, despite recent trials not showing superiority over predictive equations.
- Early enteral nutrition (EN) within 24-48 hours improves outcomes, with gradual achievement of energy and protein goals over the first week.
Conclusions:
- Individualized nutrition support tailored to variable metabolic demands is essential for critically ill patients.
- Ongoing research is expected to further refine personalized nutrition strategies in the ICU.
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