Measured Energy Expenditure Compared With Best‐Practice Recommendations for Obese, Critically Ill Patients—A Prospective Observational Study

Ridley, Emma J.; Tierney, Audrey C.; King, Sontoria D.; Ainslie, Emily; Udy, Andrew; Scheinkestel, Carlos; Nyulasi, Ibolya

doi:10.1002/jpen.1791

Cited by 17 publications

(25 citation statements)

References 12 publications

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“…4. Refeeding syndrome (RS) [18,20,21] and complications related to propofol use must be prevented. Therefore, the nutritional screening at admission should be based on:…”

Section: Nutritional Evaluation Based On the Globalmentioning

confidence: 99%

“…It is therefore even more necessary to avoid restrictive and hypocaloric nutrition in obese patients. Underfeeding is more likely in obese patients: obese patients often have increased energy expenditure compared to non-obese [20]; initiation of nutritional support is often delayed in obese ICU patients [21]. In obese ICU patients, rapid weight loss would be associated with increased loss in muscle mass, weakening the immune defenses and therefore promoting COVID-19 severity.…”

Section: Enteral Nutrition (Enmentioning

confidence: 99%

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Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance

et al. 2020

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Five to 10% of the coronavirus SARS-CoV-2-infected patients, i.e., with new coronavirus disease 2019 (COVID-19), are presenting with an acute respiratory distress syndrome (ARDS) requiring urgent respiratory and hemodynamic support in the intensive care unit (ICU). However, nutrition is an important element of care. The nutritional assessment and the early nutritional care management of COVID-19 patients must be integrated into the overall therapeutic strategy. The international recommendations on nutrition in the ICU should be followed. Some specific issues about the nutrition of the COVID-19 patients in the ICU should be emphasized. We propose a flow chart and ten key issues for optimizing the nutrition management of COVID-19 patients in the ICU.

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“…4. Refeeding syndrome (RS) [18,20,21] and complications related to propofol use must be prevented. Therefore, the nutritional screening at admission should be based on:…”

Section: Nutritional Evaluation Based On the Globalmentioning

confidence: 99%

Section: Enteral Nutrition (Enmentioning

confidence: 99%

Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance

et al. 2020

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“…In the absence of indirect calorimetry, VO2, or VCO2 measurements and simple weight-based equations (such as 20–25 kcal/kg/d) should be used. In order to prevent risks, it is important that the prescribed quantity should match the calorie requirement, and that this should be re-evaluated in regular intervals [ 28 ], as the measured energy expenditure increased in the course of time with great individual variation [ 29 ]. De Waele et al (2012) recommended a dedicated nutrition support team for a more systematic use of indirect calorimetry in long-term mechanically ventilated patients [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

et al. 2020

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Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice.

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“…However, clinical studies have failed to prove an unequivocal benefit of early high-dose nutrition support, and several prospective randomized clinical trials showed significant harm, including increased hyperglycemia, hepatic steatosis, and mortality [1][2][3][4][5]. In contrast, undernourishment is also common in ICU and post-ICU patients due to both prescription inadequacy and failure to reach the nutrition target [6][7][8][9][10][11][12]. A negative energy balance in critically ill patients is associated with increased morbidity, including increased length of hospital stay, infections, organ failure, prolonged mechanical ventilation, and even mortality [2,13].…”

Section: Introductionmentioning

confidence: 99%

Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations

2021

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The use of indirect calorimetry is strongly recommended to guide nutrition therapy in critically ill patients, preventing the detrimental effects of under- and overfeeding. However, the course of energy expenditure is complex, and clinical studies on indirect calorimetry during critical illness and convalescence are scarce. Energy expenditure is influenced by many individual and iatrogenic factors and different metabolic phases of critical illness and convalescence. In the first days, energy production from endogenous sources appears to be increased due to a catabolic state and is likely near-sufficient to meet energy requirements. Full nutrition support in this phase may lead to overfeeding as exogenous nutrition cannot abolish this endogenous energy production, and mitochondria are unable to process the excess substrate. However, energy expenditure is reported to increase hereafter and is still shown to be elevated 3 weeks after ICU admission, when endogenous energy production is reduced, and exogenous nutrition support is indispensable. Indirect calorimetry is the gold standard for bedside calculation of energy expenditure. However, the superiority of IC-guided nutritional therapy has not yet been unequivocally proven in clinical trials and many practical aspects and pitfalls should be taken into account when measuring energy expenditure in critically ill patients. Furthermore, the contribution of endogenously produced energy cannot be measured. Nevertheless, routine use of indirect calorimetry to aid personalized nutrition has strong potential to improve nutritional status and consequently, the long-term outcome of critically ill patients.

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Measured Energy Expenditure Compared With Best‐Practice Recommendations for Obese, Critically Ill Patients—A Prospective Observational Study

Cited by 17 publications

References 12 publications

Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance

Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance

Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations

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