Feeding the Critically Ill Patient

Abstract

Current evidence suggests that enteral nutrition, started as soon as possible after acute resuscitative efforts, may serve therapeutic roles beyond providing calories and protein. Although many new studies have further advanced our knowledge in this area, the appropriate level of standardization has not yet been achieved for nutrition therapy, as it has in other areas of critical care. Protocolized nutrition therapy should be modified for each institution based on available expertise, local barriers, and existing culture in the ICU to optimize evidence-based nutrition care for each critically ill patient.

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

“…44 Although optimal protein intakes for surgery are currently not clearly defined, nonsurgical nutrition guidelines suggest that stressed patients should consume at least 1.2-2.0 g of protein/kg/d. 22 Whey protein and casein are among the best quality proteins overall for muscle synthesis 45 and to stimulate anabolism in patients with advanced cancer. 46 Several studies have identified that consuming 25-35 g of protein in a single meal maximally stimulates muscle protein synthesis.…”

“…The type of nutrition support delivered in the postoperative setting is primarily determined by the patient's ability to achieve calorie (25-30 kcal/kg/d) and protein (1.5-2 g/kg/d) goals and tolerance of oral intake. 1,21,22,90 A practical approach derived from recent publications 1,21,22,90,94 indicates that patients tolerating 50%-100% of nutrition goals should receive high-protein ONS (2-3× a day) to meet protein needs. In patients consuming <50% via the oral route, EN via tube feeds should be given.…”

“…The urgency of improving perioperative nutrition practices is underscored by strong recommendations from international nutrition society guidelines endorsing perioperative nutrition optimization. [21][22][23][24] However, limited surgical/perioperative society guidelines exist on how to optimally screen surgical patients for malnutrition and optimize nutritional status in the perioperative period, particularly within an ERP. Thus, we sought to define and answer important questions related to perioperative nutrition in patients undergoing surgery within the context of an ERP.…”

Feeding adequacy among Critically Ill Patients in the Intensive Care Unit and Its Association with Clinical Outcomes: A Narrative Review

“…Studies have reported that critically ill patients receiving inadequate energy and protein are presented with poor clinical outcomes such as increased risk of infections, length of mechanical ventilations, morbidities and mortality. 7 Although the definition of underfeeding differs in various studies, but it was generally recognized that 80% of prescribed energy and protein represent adequate feeding. 8 It may be more important to ensure protein adequacy as studies have shown that improvement of clinical outcomes is associated with adequate protein intake, even after adjustment for energy adequacy.…”

“…Compare to PN, EN has additional benefits of maintaining gut structural and functional integrity, modulating metabolic response, and attenuating oxidative stress and the inflammatory response while supporting the humoral immune system. 7 Therefore, EN (i.e. tube feeding) acts as the first line nutritional therapy in mechanically ventilated critically ill patients who are unable to maintain volitional intake.…”