Nutrition Rehabilitation in the Intensive Care Unit

Massanet, P.; Petit, Laurent; Louart, Benjamin; Corne, Philippe; Richard, C.; Preiser, Jean Charles

doi:10.1177/0148607114567901

Cited by 28 publications

(21 citation statements)

References 63 publications

(67 reference statements)

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“…Successful LMV and transition from the ICU to ward marks a significant point in the trajectory of critical illness 28 and the beginning of the journey to recovery. Although no formal guidelines for transitioning patients from EN to an oral diet exist specifically for the recovering critically ill, Massanet et al 29 propose permanent discontinuation of EN only when a patient has demonstrated the ability to consume >75% of daily caloric needs. Half of the patients who transitioned from EN to an oral diet in the first 7 days following LMV, whereby EN was discontinued prior to initiation of any oral diet, did not have the opportunity for assessment of oral intake.…”

Section: Discussionmentioning

confidence: 99%

Adequacy of Protein and Energy Intake in Critically Ill Adults Following Liberation From Mechanical Ventilation Is Dependent on Route of Nutrition Delivery

et al. 2020

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Background Studies examining nutrition intake of critically ill patients following liberation from mechanical ventilation (LMV) are scarce. The objectives of this prospective, observational feasibility study were to quantify and assess protein and energy intake in hospitalized, critically ill patients following LMV, to determine barriers to optimal intake, and to report on the feasibility of recruiting and retaining patients into this study. Methods Adult patients requiring MV for >72 hours in a medical/surgical intensive care unit (ICU) were recruited. Protein and energy intakes were quantified up to 14 days following LMV. Patients also identified barriers to eating. Results Nineteen patients (mean age, 60 years [SD, 12 years]) were studied over 125 days. Over all study days, the median amounts of protein and energy consumed in comparison with amounts prescribed by dietitians were 46% (interquartile range [IQR], 26–100) and 71% (IQR, 38–100), respectively. When stratified by route of nutrition delivery, on days (n = 54) when patients consumed an oral diet as the sole nutrition source, median amounts of protein and energy consumed in comparison with those prescribed were only 27% (IQR, 15–41) and 47% (IQR, 29–66), respectively. The most frequently reported barriers to eating were poor appetite, early satiety, and taste changes. Conclusions Protein and calorie intake is below prescribed amounts for patients whose enteral nutrition is discontinued and an oral diet prescribed as sole nutrition source following LMV. Acceptable strategies to enhance nutrition intake in post‐ICU patients during the recovery stages of critical illness are needed.

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Section: Discussionmentioning

confidence: 99%

Adequacy of Protein and Energy Intake in Critically Ill Adults Following Liberation From Mechanical Ventilation Is Dependent on Route of Nutrition Delivery

et al. 2020

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“…Studies of obese individuals have reported an inverse correlation between insulin resistance and hyperinsulinemia with ghrelin concentration [3,13]. Increased plasma levels of ghrelin due to fasting have been reported to reduce after eating, especially foods rich in sugar and fat [14].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effects of continuous versus intermittent enteral feeding on plasma leptin and ghrelin levels in Intensive Care Units

et al. 2017

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Objective: The aim of this prospective randomized trial is to verify whether there is an association between the methods of administration of enteral nutrition and the leptin and ghrelin hormones, which have a major role in the regulation of energy metabolism. Methods: This study enrolled 38 enteral-fed patients aged 18 to 85 in the Intensive Care Unit. The patients were prospectively randomized to receive either continuous infusion (n=19) or intermittent feeding (n=18) of enteral nutrition. In addition to routine biochemical assays, blood samples were taken from the patients for leptin and ghrelin analyses on the 1th, 7th, and 14th days of enteral nutrition. Results: There was no statistically significant difference between the groups regarding descriptive statistics and categorical variables such as underlying diseases, complications, steroid use and others (p>0.05). The decrease in the number of white blood cells and in creatinine and C-reactive protein levels over time were statistically significant (p=0.010, p=0.026, p<0.001 respectively). There was no statistically significant difference between the groups with respect to leptin and ghrelin levels (p=0.982 and p=0.054). Leptin levels did not change over time; however, the ghrelin levels of both groups were significantly higher on the 7th and 14th days than on the first day of analysis (p=0.003). Conclusion: This study revealed that both continuous and intermittent enteral nutrition feeding regimens were well tolerated in Intensive Care Unit patients showing minor complications. The method of administration of enteral nutrition alone did not affect the leptin and ghrelin levels. Randomized controlled large cohort trials are needed to to compare intermittent and continuous enteral nutrition to determine which one is more adaptable to diurnal patterns of secretion metabolic hormones.

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“…[23][24][25] Oral feeding is a real challenge in ICUs. 12 The barriers to food intakes are numerous 26,27 and related to illness effects (such as anorexia, 28,29 changes in the perception of food taste, 30 and disturbed gastrointestinal function 31 ), eating difficulties, and organizational processes. 32 If regular and disease-specific diets are generally prepared to cover 100% of the daily energy requirements (as demonstrated by the present simulation), they provide on average only 0.8 g/kg/d protein.…”

Section: Discussionmentioning

confidence: 99%

Nutrition During Critical Care: An Audit on Actual Energy and Protein Intakes

Rougier

Preiser

Fadeur

et al. 2020

J Parenter Enteral Nutr

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Introduction: Oral nutrition is delivered frequently in intensive care units (ICUs) but rarely studied. The primary objective of this study was to quantify nutrition intakes in patients exclusively orally fed (OF) and in those receiving medical nutrition solutions or both. Methods: Adults who stayed in a mixed ICU for ≥3 days were studied. Nutrition deficits were calculated as the difference between estimated energy or protein targets (determined by weight-based formulas) and actual intakes (recorded on a daily basis by nurses). Total volumes of enteral or parenteral nutrition solutions, propofol, and glucose infused over 24 hours were collected and energy and protein amounts were calculated. In OF patients, food intake at each meal (breakfast, lunch, and dinner) was estimated using the "one-quarter portion" method. Results: Among the 289 included patients aged 67 (57-75.5) years, 253 were fed and received, on average, 14.3 (7.8-19) kcal/kg/d and 0.53 (0.27-0.8) g/kg/d protein. In OF patients (n = 126), intakes were 9.7 (5.8-19) kcal/kg/d and 0.35 (0.17-0.57) g/kg/d protein. In the subset of OF patients with ICU stay ≥ 7 days (n = 37), respectively, 51% and 94% never received ≥80% of their energy and protein targets. Conclusion: Nutrition intakes were lower by oral feeding compared with other exclusive or combined medical nutrition. Compared with the prescribed amounts, the deficit was larger for proteins than for energy.

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Nutrition Rehabilitation in the Intensive Care Unit

Cited by 28 publications

References 63 publications

Adequacy of Protein and Energy Intake in Critically Ill Adults Following Liberation From Mechanical Ventilation Is Dependent on Route of Nutrition Delivery

Adequacy of Protein and Energy Intake in Critically Ill Adults Following Liberation From Mechanical Ventilation Is Dependent on Route of Nutrition Delivery

Comparison of the effects of continuous versus intermittent enteral feeding on plasma leptin and ghrelin levels in Intensive Care Units

Nutrition During Critical Care: An Audit on Actual Energy and Protein Intakes

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