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Background: Propofol, dextrose, and citrate infusions are necessary treatment modalities in the intensive care units (ICUs). They are, however, a potential source of nonnutritive calories (NNCs), which may cause overfeeding and adverse complications. The literature surrounding the role of NNCs is limited. We aimed to examine the energy contribution of NNCs. Our secondary aim is to assess the nutrition impact of NNCs, especially among patients receiving continuous renal replacement therapy (CRRT). Materials/Methods: We enrolled 177 mechanically ventilated patients admitted to medical-surgical ICUs from August to December 2019. Patients were monitored over the first 7 days of admission. Infusion rates of enteral nutrition/parenteral nutrition and NNCs, as well as clinical characteristics, were examined. Patients receiving CRRT were compared with those without.Results: In total, 24% of patients additional energy from citrate. Patients received a maximum of 331 kcal from citrate, 492 kcal from propofol, and 992 kcal from dextrose per ICU day. CRRT group achieved higher total energy on the first 2 days (day 1: 55.1% vs 46.4%, P = 0.008; day 2: 73.2% vs 55.4%, P = 0.025). They also received higher mean NNCs on all days, except for day 1 (P = 0.068). Conclusion:NNCs, especially citrate, are significant sources of energy. Patients receiving CRRT were more likely to be malnourished. There should be close monitoring and adaption of energy prescription accordingly to prevent overfeeding.

Background Nutrition support is associated with improved survival and nonelective hospital readmission rates among malnourished medical inpatients; however, limited evidence supporting dietary counseling is available. We intend to determine the effect of dietary counseling with or without oral nutrition supplementation (ONS), compared with standard care, on hospitalized adults who are malnourished or at risk of malnutrition. Methods We searched MEDLINE/PubMed, CINAHL, Embase, Scopus, The Cochrane Library, and Google Scholar for studies listed from January 1, 2011, to August 31, 2021. Meta‐analysis was performed to obtain pooled risk ratios (RRs) and 95% CIs to estimate the effect. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of the evidence. Results Sixteen studies were identified. Compared with standard care, dietary counseling with or without ONS probably does not reduce inpatient rates of 30‐day mortality (RR = 1.24; 0.60–2.55; I2 = 45%; P = 0.56; moderate certainty), slightly reduces 6‐month mortality (RR = 0.83; 0.69–1.00; I2 = 16%; P = 0.06; high certainty), reduces complications (RR = 0.85; 0.73–0.98; I2 = 0%; P = 0.03; high certainty), and may slightly reduce readmission (RR = 0.83; 0.66–1.03; I2 = 55%; P = 0.10; low certainty) but may not reduce length of stay (mean difference: −0.75 days; −1.66‐0.17; I2 = 70%; P = 0.11; low certainty). Intervention may result in slight improvements in nutrition status/intake and weight/body mass index (low certainty). Conclusions There is an increase in the certainty of evidence regarding the positive impact of dietary counseling on outcomes. Future studies should standardize and provide details/frequencies of counseling methods and ONS adherence to determine dietary counseling effectiveness.

In biomedical and public health studies, interval-censored data arise when the failure time of interest is not exactly observed and instead only known to lie within an interval. Furthermore, the failure time and censoring time may be dependent. There may also exist a cured subgroup, meaning that a proportion of study subjects are not susceptible to the failure event of interest. Many authors have investigated inference procedure for interval-censored data. However, most existing methods either assume no cured subgroup or apply only to limited situations such that the failure time and the observation time have to be independent. To take both cured subgroups and informative censoring into consideration for regression analysis of intervalcensored data, we employ a mixture cure model and propose a sieve maximum likelihood estimation approach using Bernstein Polynomials. A novel expectation-maximization algorithm with the use of subject-specific independent log-normal latent variable is developed to obtain the numerical solutions of the model. The robustness and finite-sample performance of the proposed method in terms of estimation accuracy and predictive power is evaluated by an extensive simulation study which suggest that the proposed method works well for practical situations. In addition, we provide an illustrative example using NASA's hypobaric decompression sickness database (HDSD).

Background: COVID-19 can lead to critical illness and induce hypermetabolism, protein catabolism, and inflammation. These pathological processes may alter energy and protein requirements, and certain micronutrients may attenuate the associated detriments. This narrative review summarizes the macronutrient and micronutrient requirements and therapeutic effects in critically ill patients with SARS-CoV-2.Methods: We searched four databases for randomized controlled trials (RCTs) and studies that measured macronutrient and micronutrient requirements, published from February 2020 to September 2022.Results: Ten articles reported on energy and protein requirements, and five articles reported the therapeutic effects of ω-3 (n = 1), group B vitamins (n = 1), and vitamin C (n = 3). Patients' resting energy expenditure gradually increased with time, measuring approximately 20 kcal/kg body weight (BW), 25 kcal/kg BW, and 30 kcal/kg BW for the first, second, and third week onwards, respectively. Patients remained in negative nitrogen balances in the first week, and a protein intake of ≥1.5 g/kg BW may be necessary to achieve nitrogen equilibrium. Preliminary evidence suggests that ω-3 fatty acids may protect against renal and respiratory impairments. The therapeutic effects of group B vitamins and vitamin C cannot be ascertained, although intravenous vitamin C appears promising in reducing mortality and inflammation. Conclusion:There are no RCTs to guide the optimal dose of energy and protein in critically ill patients with SARS-CoV-2. Additional larger-scale, well-designed RCTs are needed to elucidate the therapeutic effects of ω-3, group B vitamins, and vitamin C.