New Trends in ICU nutrition
Who Should Eat? All patients admitted to the intensive care unit (ICU) for more than 48 hours should be given special attention due to nutritional risk. The composite score is not very different from that of other inpatients.
When and how?
It should be used if oral or enteral routes are available. If the enteral route is not possible, parenteral nutrition (PN) should be administered at a later stage within 7 days of hospitalization.This a new protocols and trends in ICU nutrition coming up gradually. Historically, numerous observational studies have shown that low calorie and protein intake is associated with poor outcomes early in acute disease, followed by 3 calories. The goal is to increase the delivery of up to 80-100% of the measured EE, if using reliable measurement methods, and finally the post-pyloric pathway.
Pharmaconutriments Additional enteral doses of glutamine is limited to patients with burns or serious injuries exceeding 20% of body surface area. Intravenous supplementation is also not recommended in patients with unstable or difficult ICU with hepatic or renal impairment. The use of omega-3 fatty acids in the gut is limited to dietary intake. For the first time in a recent interventional study guidelines focus on vitamin D and recommend high-dose and high-dose supplementation for severe deficiencies.
The importance of identifying dysphagia that may limit oral food intake under certain conditions was emphasized. Early EPI has also been proposed for patients classically unsuitable for EPI closely monitoring blood sugar and electrolyte levels is still the rule. Particular attention is paid to the identification and treatment of the refeeding syndrome.
Many recommendations are not based on convincing evidence, and a group of experts has published an agenda for nutritional and metabolic research that should be undertaken over the next decade. It is hoped that this future study will provide a clearer and more practical position for food control practitioners. The Narrative Review is intended to summarize relevant research from the past two years and provide context for understanding the results.
Recent studies in the intensive care unit have provided insight into the pathophysiology and epidemiology of metabolic and endocrine disorders that interact with catabolism, anabolic resistance, and caloric and protein intake.
The early supply of high protein intake and high-calorie intake may be harmful.
Resting Eating Syndrome requires calorie restriction and phosphate monitoring to identify patients at risk.
A recent study found that enteral nutrition is no longer superior to parenteral nutrition.
Medical nutrition therapy for critically ill patients remains a challenge. The absence of studies focusing on early or prolonged stay does not allow for refining nutritional prescriptions in these conditions. Critical care patients are a heterogeneous group and it is not possible to make unique recommendations for each patient and situation. Each diagnosis, period (early, post-resuscitation, stable, prolonged stay) and any associated complications must be taken into account. However, these guidelines are based on the best current knowledge and evidence providing a broad range of nutritional recommendations in the clinical situations most commonly encountered in daily intensive care practice.