Nutrition Therapy in Critically Ill Adults

Area of Science:

• Critical care medicine
• Clinical nutrition
• Metabolic response to critical illness

Background:

• Adults in acute critical illness experience severe catabolism, inflammation, muscle loss, and gut dysfunction, impacting nutritional needs.
• Early enteral nutrition (EN) supports gut health, but parenteral nutrition (PN) is a safe alternative if EN is not feasible.

Purpose of the Study:

• To review current evidence on nutritional strategies in acute critical illness.
• To guide precise, phase-specific nutrition for optimal patient recovery and muscle preservation.

Main Methods:

• Analysis of large clinical trials on energy and protein dosing in critical care.
• Review of adverse events associated with enteral nutrition and strategies for safe delivery.

Main Results:

• Early full-dose energy delivery provides no benefit over restrictive dosing and may increase complications.
• High-dose protein shows no advantage and may harm patients with acute kidney injury.
• Adverse events are common with EN, necessitating gradual advancement and specific preventative strategies.

Conclusions:

• Restrictive energy and standard protein dosing strategies are recommended, particularly for patients at risk of refeeding syndrome or with circulatory shock.
• Safe nutrition delivery involves gradual advancement, refeeding syndrome prevention, glycemic control, and avoiding routine gastric residual volume monitoring.
• Patient heterogeneity necessitates biomarker-guided, phase-specific nutrition to preserve lean muscle mass and enhance recovery.