ESPEN guideline on clinical nutrition in the intensive care unit

Abstract

s u m m a r yFollowing the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to start and how to progress in the administration of adequate provision of nutrients is also described. The best determination of amount and nature of carbohydrates, fat and protein are suggested. Special attention is given to glutamine and omega-3 fatty acids. Particular conditions frequently observed in intensive care such as patients with dysphagia, frail patients, multiple trauma patients, abdominal surgery, sepsis, and obesity are discussed to guide the practitioner toward the best evidence based therapy. Monitoring of this nutritional therapy is discussed in a separate document.

Lipid Use in Hospitalized Adults Requiring Parenteral Nutrition

“…ESPEN guidelines for parenteral nutrition in ICU patients recommend that the administration of intravenous lipid emulsions should be generally a part of parenteral nutrition and that lipid emulsions enriched with EPA and DHA (fish oil dose 0.1–0.2 g/kg/d) can be provided in patients receiving parenteral nutrition . The authors at the current lipid meeting were also in agreement with this dose range, for stable, critically ill, adult patients requiring parenteral nutrition (Table ).…”

“…The authors at the current lipid meeting were also in agreement with this dose range, for stable, critically ill, adult patients requiring parenteral nutrition (Table ). The ESPEN guidelines report that evidence of ω‐3 enriched emulsions in non‐surgical ICU patients is not sufficient to mention this as a stand‐alone recommendation, referencing the 2018 review by the ESPEN expert group . This review stated that fish‐oil enriched parenteral nutrition was well tolerated and confers additional clinical benefits, particularly in surgical patients, but that the evidence in non‐surgical ICU patients is less clear .…”

“…Lipid emulsions are a principle part of parenteral nutrition, minimizing dependence on glucose as a major source of non‐protein energy and preventing essential fatty acid deficiency (EFAD) . Lipid oil sources can also be characterized by their relative range of inflammatory effects: soybean oil, which contains a high concentration of linoleic acid, is more inflammatory than either medium‐chain triglycerides (MCTs) or olive oil, while fish oil is even less inflammatory and possibly even anti‐inflammatory .…”

Predictive energy equations are inaccurate for determining energy expenditure in adult burn injury: a retrospective observational study

“…1,2,8,9 However, overfeeding may also be harmful in critical illness, 10 and result in hyperglycaemia, fatty infiltration of organs, metabolic acidosis and carbon dioxide retention, 11 impair weaning of ventilation and increased mortality and intensive care unit (ICU) length of stay. 4,13 However, IC is not routinely used in most Australian burns centres, 14 despite recommendations for its use in critical care 13,15 and in burns, 4 and many burn centres use predictive energy equations to estimate the nutritional requirements of burns patients. 4,13 However, IC is not routinely used in most Australian burns centres, 14 despite recommendations for its use in critical care 13,15 and in burns, 4 and many burn centres use predictive energy equations to estimate the nutritional requirements of burns patients.…”

“…2 These equations use a range of patient-specific factors such as age, burn size and height and/or weight to predict energy requirements (Table S1). 13,17 The objectives of this study were (i) to assess agreement between measured EE (mEE) measured using IC and predicted energy requirements (pERs) using published predictive equations, and (ii) to correlate mEE with clinical parameters to identify associations with the degree of hypermetabolism (mEE%predBMR) in adults with severe burn injury. In the broader critically ill population, these equations are known to be inaccurate compared to IC.…”