Relationship of energy and protein adequacy with 60-day mortality in mechanically ventilated critically ill patients: A prospective observational study

Lee, Zheng‐Yii; Ibrahim, Noor Akma; Yusof, Barakatun Nisak Mohd

doi:10.1016/j.clnu.2017.05.013

Cited by 38 publications

(45 citation statements)

References 26 publications

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“…Although we do not have strong data about improved mortality outcomes, observational studies have suggested that full enteral feedings are associated with improved outcomes in nutritionally high-risk critically ill patients. 53,54,96 This again emphasizes the fact that baseline nutrition status of patients is a strong predictor for clinical outcomes in nutrition studies.…”

Section: Protein or Energy Dilemma: Optimization Is The Keymentioning

confidence: 96%

Pathophysiology of Critical Illness and Role of Nutrition

2018

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Critical illness is a hypercatabolic state. It has been hypothesized that timely and adequate nutrition support may optimize the host response and thereby minimize nutritionally related complications while improving overall outcome. Any illness in due course can lead to a malnourished state—critical illness can worsen this state as patients may become immunocompromised and unable to mount an adequate inflammatory response and therefore susceptible to poor outcomes. Data indicate that prevalence of malnutrition in the ICU ranges from 38% to 78% and is independently associated with poor outcomes. Hence, exploring the role of nutrition as a way to mitigate critical illness is important. In this review, the basic pathophysiology of critical illness and how it alters carbohydrate, protein, and fat metabolism are discussed. This is followed by a discussion of malnutrition and how it affects patient and hospital outcomes. Finally, a summary of the available evidence regarding nutrition support and its impact on outcomes are provided. This review is not intended to provide practice‐based guidelines; instead, it intends to highlight available data on the role of nutrition support in critically ill patients.

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Section: Protein or Energy Dilemma: Optimization Is The Keymentioning

confidence: 96%

Pathophysiology of Critical Illness and Role of Nutrition

2018

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“…25 Jeejeebhoy pointed out that lower rates of nutrient provision have frequently been associated with better clinical outcomes in critically ill patients. 17,18,50,51 But many other studies have found the opposite: that patients who received more nutrients had better clinical outcomes. 17,[52][53][54][55][56][57][58] Both conclusions can't be correct, or they are correct in different situations.…”

Section: Permissive Underfeeding and Clinical Outcomesmentioning

confidence: 97%

High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients

Hoffer

2018

Nut in Clin Prac

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High-protein hypocaloric nutrition, tailored to each patient's muscle mass, protein-catabolic severity, and exogenous energy tolerance, is the most plausible nutrition therapy in protein-catabolic critical illness. Sufficient protein provision could mitigate the rapid muscle atrophy characteristic of this disease while providing urgently needed amino acids to the central protein compartment and sites of tissue injury. The protein dose may range from 1.5 to 2.5 g protein (1.8-3.0 g free amino acids)/kg dry body weight per day. Nutrition should be low in energy (≈70% of energy expenditure or ≈15 kcal/kg dry body weight per day) because efforts to match energy provision to energy expenditure are physiologically irrational, risk toxic energy overfeeding, and have repeatedly failed in large clinical trials to demonstrate clinical benefit. The American Society for Parenteral and Enteral Nutrition currently suggests high-protein hypocaloric nutrition for obese critically ill patients. Short-term high-protein hypocaloric nutrition is physiologically and clinically sensible for most protein-catabolic critically ill patients, whether obese or not.

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“…The NUTRIC score was developed in studies of critically ill patient populations and has been validated in many observational studies from different countries. 11,[14][15][16][17][18][19][20][21][22][23] As IL-6 is not routinely performed in most ICUs in the world, the modified-NUTRIC (mNUTRIC) score without IL-6 was proposed and revalidated. 14 However, one of the major limitations of the NUTRIC/mNUTRIC score is the absence of classical nutrition variables such as recent food intake and weight change.…”

Section: Nutrition Risk Screeningmentioning

confidence: 99%

“…11,[14][15][16][20][21][22][23] Various observational studies in different populations have also shown that clinical outcomes are modified by nutrition adequacy depending on the risk status of the patients (Table 1). 11,14,[16][17][18][19] The NUTRIC/mNUTRIC score remains to be prospectively tested in a randomized controlled trial. There have been inconsistent results from post hoc analyses of prospective randomized trials.…”

Section: Nutrition Risk Screeningmentioning

confidence: 99%

Determination of Nutrition Risk and Status in Critically Ill Patients: What Are Our Considerations?

Lee

Heyland

2018

Nut in Clin Prac

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The stress catabolism state predisposes critically ill patients to a high risk of malnutrition. This, coupled with inadequate or delayed nutrition provision, will lead to further deterioration of nutrition status. Preexisting malnutrition and iatrogenic underfeeding are associated with increased risk of adverse complications. Therefore, accurate detection of patients who are malnourished and/or with high nutrition risk is important for timely and optimal nutrition intervention. Various tools have been developed for nutrition screening and assessment for hospitalized patients, but not all are studied or validated in critically ill populations. In this review article, we consider the pathophysiology of malnutrition in critical illness and the currently available literature to develop recommendations for nutrition screening and assessment. We suggest the use of the (modified) Nutrition Risk in the Critically Ill (mNUTRIC) for nutrition risk screening and the subjective global assessment (SGA) together with other criteria relevant to the critically ill patients, such as gastrointestinal function, risk of aspiration, determination of sarcopenia and frailty, and risk of refeeding syndrome for nutrition assessment. Further research is needed to identify suitable nutrition monitoring indicators to determine the response to the provision of nutrition.

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Relationship of energy and protein adequacy with 60-day mortality in mechanically ventilated critically ill patients: A prospective observational study

Cited by 38 publications

References 26 publications

Pathophysiology of Critical Illness and Role of Nutrition

Pathophysiology of Critical Illness and Role of Nutrition

High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients

Determination of Nutrition Risk and Status in Critically Ill Patients: What Are Our Considerations?

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