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guidelines·critical care, nutrition, clinical nutrition, micronutrients, internal medicine·PMC10318839

Personalized nutrition therapy in critical care: 10 expert recommendations

Critical Care · 11 authors, 13 centres

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TL;DR

The recommendations cover initiating low-dose enteral nutrition (EN) or parenteral nutrition (PN) within 48 hours of admission, with EN preferred but PN also being safe and effective.

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The recommendations cover initiating low-dose enteral nutrition (EN) or parenteral nutrition (PN) within 48 hours of admission, with EN preferred but PN also being safe and effective. Indirect calorimetry is recommended to measure energy expenditure after stabilization, with targets set below the measured value (~70%) initially and increased later.

STUDY TYPE

guidelines

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critical care

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10318839

Personalized nutrition therapy in critical care: 10 expert recommendations

Critical Care

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ABSTRACT

Personalization of ICU nutrition is essential to future of critical care. Recommendations from American/European guidelines and practice suggestions incorporating recent literature are presented. Low-dose enteral nutrition (EN) or parenteral nutrition (PN) can be started within 48 h of admission. While EN is preferred route of delivery, new data highlight PN can be given safely without increased risk; thus, when early EN is not feasible, provision of isocaloric PN is effective and results in similar outcomes. Indirect calorimetry (IC) measurement of energy expenditure (EE) is recommended by both European/American guidelines after stabilization post-ICU admission. Below-measured EE (~ 70%) targets should be used during early phase and increased to match EE later in stay. Low-dose protein delivery can be used early (~ D1-2) (< 0.8 g/kg/d) and progressed to ≥ 1.2 g/kg/d as patients stabilize, with consideration of avoiding higher protein in unstable patients and in acute kidney injury not on CRRT. Intermittent-feeding schedules hold promise for further research. Clinicians must be aware of delivered energy/protein and what percentage of targets delivered nutrition represents. Computerized nutrition monitoring systems/platforms have become widely available. In patients at risk of micronutrient/vitamin losses (i.e., CRRT), evaluation of micronutrient levels should be considered post-ICU days 5–7 with repletion of deficiencies where indicated. In future, we hope use of muscle monitors such as ultrasound, CT scan, and/or BIA will be utilized to assess nutrition risk and monitor response to nutrition. Use of specialized anabolic nutrients such as HMB, creatine, and leucine to improve strength/muscle mass is promising in other populations and deserves future study. In post-ICU setting, continued use of IC measurement and other muscle measures should be considered to guide nutrition. Research on using rehabilitation interventions such as cardiopulmonary exercise testing (CPET) to guide post-ICU exercise/rehabilitation prescription and using anabolic agents such as testosterone/oxandrolone to promote post-ICU recovery is needed.

CITATION EXPORT

Paul E. Wischmeyer, Danielle E. Bear, Mette M. Berger et al.. Personalized nutrition therapy in critical care: 10 expert recommendations. Critical Care. (2023). https://doi.org/10.1186/s13054-023-04539-x

AUTHORS

11 · 13 CENTRES

Paul E. Wischmeyer, Danielle E. Bear, Mette M. Berger, Elisabeth De Waele, Jan Gunst, Stephen A. McClave, Carla M. Prado, Zudin Puthucheary, Emma J. Ridley, Greet Van den Berghe, Arthur R. H. van Zanten

1grid.26009.3d0000 0004 1936 7961Department of Anesthesiology and Surgery, Duke University School of Medicine, Box 3094 Mail # 41, 2301 Erwin Road, 5692 HAFS, Durham, NC USA
2grid.420545.20000 0004 0489 3985Departments of Nutrition and Dietetics and Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
3grid.9851.50000 0001 2165 4204Faculty of Biology & Medicine, Lausanne University, Lausanne, Switzerland
4grid.411326.30000 0004 0626 3362Department of Clinical Nutrition, Universitair Ziekenhuis Brussel, Brussels, Belgium
5grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel, Brussels, Belgium
6grid.5596.f0000 0001 0668 7884Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Louvain, Belgium
7grid.266623.50000 0001 2113 1622Department of Medicine, University of Louisville School of Medicine, Louisville, KY USA
8grid.17089.370000 0001 2190 316XDepartment of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB Canada
9grid.4868.20000 0001 2171 1133William Harvey Research Institute, Queen Mary University of London, London, UK
10grid.416041.60000 0001 0738 5466Royal London Hospital, Barts Health NHS Trust, London, UK
11grid.1002.30000 0004 1936 7857Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, VIC 3004 Australia
12grid.1623.60000 0004 0432 511XDietetics and Nutrition, Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004 Australia
13grid.415351.70000 0004 0398 026XDepartment of Intensive Care, Gelderse Vallei Hospital, Wageningen University & Research, Ede, The Netherlands