Impact of the reduction of the recommended energy target in the ICU on protein delivery and clinical outcomes

Berger, Mette M.; Soguel, Ludivine; Charrière, M.; Theriault, Brandon M; Pralong, François P.; Schaller, M. D.

doi:10.1016/j.clnu.2015.12.002

Cited by 20 publications

(21 citation statements)

References 32 publications

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“…18,[36][37][38][39][40][41] The low protein-to-calorie ratio of most EN products makes the shortfall in protein provision especially serious. 21,[42][43][44] Recognizing that widely used EN regimens systematically fall short of their nutrition target, clinical investigators in several centers carried out large randomized clinical trials (RCTs) that compared standard (inadequate) EN with the same EN supplemented with PN that infused large amounts of dextrose but very little protein substrate. When these trials indicated no overall difference in clinical outcomes, a high-profile clinical practice review endorsed "permissive underfeeding" (protein-deficient low-energy EN) for at least the first week of a patient's stay in an intensive care unit (ICU), on the grounds that there is no good evidence that doing otherwise improves clinical outcomes.…”

Section: Evolution Of Critical Care Nutritionmentioning

confidence: 99%

High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients

Hoffer

2018

Nut in Clin Prac

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High-protein hypocaloric nutrition, tailored to each patient's muscle mass, protein-catabolic severity, and exogenous energy tolerance, is the most plausible nutrition therapy in protein-catabolic critical illness. Sufficient protein provision could mitigate the rapid muscle atrophy characteristic of this disease while providing urgently needed amino acids to the central protein compartment and sites of tissue injury. The protein dose may range from 1.5 to 2.5 g protein (1.8-3.0 g free amino acids)/kg dry body weight per day. Nutrition should be low in energy (≈70% of energy expenditure or ≈15 kcal/kg dry body weight per day) because efforts to match energy provision to energy expenditure are physiologically irrational, risk toxic energy overfeeding, and have repeatedly failed in large clinical trials to demonstrate clinical benefit. The American Society for Parenteral and Enteral Nutrition currently suggests high-protein hypocaloric nutrition for obese critically ill patients. Short-term high-protein hypocaloric nutrition is physiologically and clinically sensible for most protein-catabolic critically ill patients, whether obese or not.

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Section: Evolution Of Critical Care Nutritionmentioning

confidence: 99%

High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients

Hoffer

2018

Nut in Clin Prac

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“…23 Similar oversight is demonstrated in the internal quality evaluation study reported by Berger et al when a reduced target energy protocol was implemented in an ICU without RDN advisement. There was an unintentional significant decline in protein delivery from 81 g/d to 65 g/d with the reduced energy intake, resulting in protein intakes ≤1 g/kg/d for the majority of patients . The 2016 SCCM/ASPEN guidelines recommend protein intakes between 1.2 and 2.0 g/kg/d during critical illness .…”

Section: Discussionmentioning

confidence: 99%

Effect of Registered Dietitian Nutritionist Order‐Writing Privileges on Enteral Nutrition Administration in Selected Intensive Care Units

et al. 2019

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Background: Adequate nutrition is linked to improved patient outcomes during critical illness. Nutrition care is further enhanced by registered dietitian nutritionist (RDN) order-writing privileges, which improve the implementation of nutrition interventions. The purpose of this performance improvement project was to evaluate the effect of RDN order-writing privileges on enteral nutrition (EN) order compliance and nutrition delivery in selected intensive care units (ICUs) at a university-affiliated teaching hospital. Methods: screened for eligibility. Demographic and nutrition data were collected retrospectively from the electronic health record. Percent of energy and protein needs met were calculated. Data were compared with historical internal controls identified prior to RDN order-writing privileges. Results: Fifty adult patients (150 EN days) were included in data analysis, with 93 patients (279 EN days) included in historical data. Compared with historical data, cumulative EN order compliance increased by 17% and tube feed infusion rate compliance by 15% post-RDN order-writing privileges. Mean (± SD) protein needs delivered significantly increased from 72.1 ± 28.6% to 89.1 ± 24.8% after RDN order-writing implementation (P < 0.001). Conclusions: RDN order-writing privileges improved EN order compliance and significantly improved protein delivery in selected ICUs. Future studies are recommended to confirm these results and determine if other variables besides protein delivery are statistically significant with a larger sample size. (Nutr Clin Pract. 2019;34:899-905)

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“…Even in patients already known to be nutritionally at risk, 74% do not receive minimum nutrition goals . If calories provided is low (even intentionally low because of permissive underfeeding strategies), protein delivery is likely to be inadequate; this low protein delivery has been associated with longer LOS (ICU and overall hospitalization) and increased ventilator time …”

Section: Energy Needsmentioning

confidence: 99%

Enteral Nutrition in the Mechanically Ventilated Patient

Allen

Hoffman

2019

Nut in Clin Prac

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Mechanically ventilated patients are unable to take food orally and therefore are dependent on enteral nutrition for provision of both energy and protein requirements. Enteral nutrition is supportive therapy and may impact patient outcomes in the intensive care unit. Early enteral nutrition has been shown to decrease complications and hospital length of stay and improve the prognosis at discharge. Nutrition support is unique for patients on mechanical ventilation and, as recently published literature shows, should be tailored to the individuals' underlying pathology. This review will discuss the most current literature and recommendations for enteral nutrition in patients receiving mechanical ventilation. (Nutr Clin Pract. 2019;34:540-557)

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Impact of the reduction of the recommended energy target in the ICU on protein delivery and clinical outcomes

Cited by 20 publications

References 32 publications

High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients

High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients

Effect of Registered Dietitian Nutritionist Order‐Writing Privileges on Enteral Nutrition Administration in Selected Intensive Care Units

Enteral Nutrition in the Mechanically Ventilated Patient

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