Impact of caloric intake in critically ill patients with, and without, refeeding syndrome: A retrospective study

Olthof, Laura E.; Koekkoek, W.A.C.; Setten, Coralien van; Kars, Johannes Cornelis Nicolaas Hans; Blokland, Dick van; Zanten, Arthur R. H. van

doi:10.1016/j.clnu.2017.08.001

Cited by 116 publications

(109 citation statements)

References 27 publications

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“…RS was observed in 36.8% of patients, with no statistically significant difference in hospital morbidity, and with a trend toward reduced length of stay, in the lower‐calorie group. They also found that low calorie intake was associated with an increased overall survival at day 180 109 …”

Section: Avoidance Of Refeeding Syndromementioning

confidence: 99%

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ASPEN Consensus Recommendations for Refeeding Syndrome

Silva¹,

et al. 2020

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Introduction In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations. Methods Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee. Findings/Recommendations This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%–20% (mild), 20%–30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories. Conclusions These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.

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Section: Avoidance Of Refeeding Syndromementioning

confidence: 99%

“…Diseases and Clinical Conditions Associated With anIncreased Risk of Refeeding Syndrome 15,[109][110][111]. …”

mentioning

confidence: 99%

ASPEN Consensus Recommendations for Refeeding Syndrome

Silva¹,

et al. 2020

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“…Likewise, in patients developing refeeding syndrome after initiation of artificial feeding, nutrient restriction dramatically improved survival . Of note, a recent observational study found that patients developing refeeding syndrome could not be identified in advance, which broadens caution not to advance nutrition too aggressively to all ICU patients …”

Section: Results From Recent Feeding Rctsmentioning

confidence: 99%

“…36 Of note, a recent observational study found that patients developing refeeding syndrome could not be identified in advance, which broadens caution not to advance nutrition too aggressively to all ICU patients. 37 Several experts have attributed the neutral or negative impact of early enhanced feeding in RCTs to the relatively low amount of administered proteins. [38][39][40] However, 1 recent RCT that specifically evaluated a higher vs lower protein dose failed to demonstrate a beneficial impact of a higher protein dose.…”

Section: Results From Recent Feeding Rctsmentioning

confidence: 99%

Autophagy and Its Implications Against Early Full Nutrition Support in Critical Illness

2018

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The timing, dose, and route of early nutrition support in critically ill patients have been highly controversial for years. Despite the association of a caloric deficit with adverse outcome, several recent large, randomized, controlled trials have demonstrated a prolongation of organ failure and increased muscle weakness with increasing doses of nutrition in the acute phase of critical illness. A potential explanation for the negative impact of early, full feeding on outcome is feeding-induced suppression of autophagy, a cellular repair process that is necessary to clear intracellular damage. Whether nutrition management in critically ill patients should be guided by its effects on autophagy is a topic of debate. Currently, however, autophagy cannot be monitored in clinical practice. Moreover, clinical management should be guided by high-quality randomized controlled trials, which currently do not support the use of early full nutrition support.

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“…4 Low caloric intake feeding can decrease the 6 month mortality rate by 60% of RFS patients on mechanical ventilators for more than seven days, compared to a high caloric intake group. 13 This is also supported by the systematic review that showed caloric restriction with a protocol can improve mortality and survival time. 7 Regarding the composition of the diet, high carbohydrate intake is more likely to cause RFS in contrast to the low amino acid intake.…”

Section: Caloric Requirementmentioning

confidence: 65%