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  • How to Feed the Critically Ill-A Review

    Author(s)
    Lew, Charles CH
    Ong, Chengsi
    Mukhopadhyay, Amartya
    Marshall, Andrea
    Arabi, Yaseen M
    Griffith University Author(s)
    Marshall, Andrea
    Year published
    2020
    Metadata
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    Abstract
    INTRODUCTION: Number of recently published studies on nutritional support in the intensive care unit (ICU) have resulted in a paradigm shift of clinical practices. This review summarises the latest evidence in four main topics in the ICU, namely: (1) function of validated nutrition screening/assessment tools, (2) types and validity of body composition measurements, (3) optimal energy and protein goals, and (4) delivery methods. METHODS: Recent studies that investigated the above aims were outlined and discussed. In addition, recent guidelines were also compared to highlight the similarities and differences in their approach ...
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    INTRODUCTION: Number of recently published studies on nutritional support in the intensive care unit (ICU) have resulted in a paradigm shift of clinical practices. This review summarises the latest evidence in four main topics in the ICU, namely: (1) function of validated nutrition screening/assessment tools, (2) types and validity of body composition measurements, (3) optimal energy and protein goals, and (4) delivery methods. METHODS: Recent studies that investigated the above aims were outlined and discussed. In addition, recent guidelines were also compared to highlight the similarities and differences in their approach to the nutrition support of critically ill patients. RESULTS: Regardless of nutritional status and body composition, all patients with >48 hours of ICU stay are at nutrition risk and should receive individualised nutrition support. Although a recent trial did not demonstrate an advantage of indirect calorimetry over predictive equations, it was recommended that indirect calorimetry be used to set energy targets with better accuracy. Initiation of enteral nutrition (EN) within 24-48 hours was shown to be associated with improved clinical outcomes. The energy and protein goals should be achieved gradually over the first week of ICU stay. This practice should be protocolised and regularly audited as critically ill patients receive only part of their energy and protein goals. CONCLUSIONS: Metabolic demands of critically ill patients can be variable and nutrition support should be tailored to each patient. Given that many nutrition studies are on-going, we anticipate improvements in the individualisation of nutrition support in the near future.
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    Journal Title
    Annals, Academy of Medicine, Singapore
    Volume
    49
    Issue
    8
    DOI
    https://doi.org/10.47102/annals-acadmedsg.202064
    Subject
    Clinical Sciences
    Opthalmology and Optometry
    Science & Technology
    Life Sciences & Biomedicine
    Medicine, General & Internal
    General & Internal Medicine
    Critical care
    Publication URI
    http://hdl.handle.net/10072/400769
    Collection
    • Journal articles

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