Pierre Singer1, Michael Hiesmayr2, Gianni Biolo3, Thomas W Felbinger4, Mette M Berger5, Christiane Goeters6, Jens Kondrup7, Christian Wunder8, Claude Pichard9. 1. General Intensive Care Department and Institute of Nutrition Research, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, Israel. Electronic address: psinger@clalit.org.il. 2. Department of Anaesthesia, General Intensive Care and Pain Control, Medical University Vienna, Austria. 3. Universita degli Studi di Trieste, Faculta di Medicina e Chirurgia, Strada di Fiume 447, Osp di Cattinara, 34149 Trieste, Italy. 4. Department of Anesthesiology, Critical Care and Pain Medicine, Neuperlach Medical Center, The Munich Municipal Hospital Ltd, Munich, Germany. 5. Service de Médecine Intensive Adulte & Brûlés CHUV, 1011 Lausanne, Switzerland. 6. Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany. 7. Rigshospitalet, University of Copenhagen, Denmark. 8. Universitatsklinikum Wurzburg, Klinik und Poliklinik fur Anesthesiologie, Oberdurrbacher Str 6, 97080 Wurzburg, Germany. 9. Clinical Nutrition - Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
Abstract
BACKGROUND & AIMS: Since the publications of the ESPEN guidelines on enteral and parenteral nutrition in ICU, numerous studies have added information to assist the nutritional management of critically ill patients regarding the recognition of the right population to feed, the energy-protein targeting, the route and the timing to start. METHODS: We reviewed and discussed the literature related to nutrition in the ICU from 2006 until October 2013. RESULTS: To identify safe, minimal and maximal amounts for the different nutrients and at the different stages of the acute illness is necessary. These amounts might be specific for different phases in the time course of the patient's illness. The best approach is to target the energy goal defined by indirect calorimetry. High protein intake (1.5 g/kg/d) is recommended during the early phase of the ICU stay, regardless of the simultaneous calorie intake. This recommendation can reduce catabolism. Later on, high protein intake remains recommended, likely combined with a sufficient amount of energy to avoid proteolysis. CONCLUSIONS: Pragmatic recommendations are proposed to practically optimize nutritional therapy based on recent publications. However, on some issues, there is insufficient evidence to make expert recommendations.
BACKGROUND & AIMS: Since the publications of the ESPEN guidelines on enteral and parenteral nutrition in ICU, numerous studies have added information to assist the nutritional management of critically illpatients regarding the recognition of the right population to feed, the energy-protein targeting, the route and the timing to start. METHODS: We reviewed and discussed the literature related to nutrition in the ICU from 2006 until October 2013. RESULTS: To identify safe, minimal and maximal amounts for the different nutrients and at the different stages of the acute illness is necessary. These amounts might be specific for different phases in the time course of the patient's illness. The best approach is to target the energy goal defined by indirect calorimetry. High protein intake (1.5 g/kg/d) is recommended during the early phase of the ICU stay, regardless of the simultaneous calorie intake. This recommendation can reduce catabolism. Later on, high protein intake remains recommended, likely combined with a sufficient amount of energy to avoid proteolysis. CONCLUSIONS: Pragmatic recommendations are proposed to practically optimize nutritional therapy based on recent publications. However, on some issues, there is insufficient evidence to make expert recommendations.