Nutrition in the acute phase of critical illness

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Casaer, M. P., & Van den Berghe, G. (2014). Nutrition in the acute phase of critical     illness. New England Journal of Medicine, 370(13), 1227-1236.

Nutrition in the acute phase of critical illness

Food consumption and adequate nutritional intake are critical topics when considering patients in the intensive care unit (ICU). Critically ill patients that require vital organ support commonly have a loss of appetite and may be unable to eat by mouth for an extended period of time. Providing nutrition via enteral or parenteral nutrition can aid in reducing the incidence of patients experiencing energy deficits, which are closely associated with adverse outcomes. The degree of energy deficit that accumulated in a critically ill patient is strongly correlated with their duration of stay in the ICU. This can in turn increase the risk of infectious complications and ultimately death. Often times, patients who are fed early via enteral nutrition are seen to have better outcomes than those who were not. However, much research has not been performed regarding if the enteral nutrition route is truly safer and better to start ICU patients on when compared to parenteral nutrition. Energy requirements of critically ill patients are often debated as well. Some professionals recommend basing estimations on the patient’s status before the onset of illness. Others argue that requirements differ per patient per day and should be closely monitored based on oxygen consumption and CO2 production. One large study among a meta-analysis found that there was no difference in acute or long-term functional outcomes between patients assigned an approach that allowed underfeeding and those assigned to early full feeding. Often times, the enteral route can result in adequate nutrition being met. It remains currently unknown whether early parenteral nutrition is beneficial to patients that have an absolute or prolonged contraindication to enteral nutrition. This articles recommends more research be done to look at biomarkers and scoring systems to aim at identifying patients who are able to effectively use macronutrients for recovery and will therefore be more likely to benefit from aggressive earlier nutrition.

KS

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