Nutrition in the ICU: proof of the pudding is in the tasting

Singer, Pierre; Cohen, Jonathan

doi:10.1007/s00134-014-3537-8

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…First, our study of nutrition practices revealed that more than three-quarters of the patients received nutrition support in the ICU and that their energy and especially protein intakes were below recommended targets. These results are consistent with those reported in recent nutrition trials [ 28 ]. A possible explanation might be the difficulties in reaching energy targets via the enteral route, chosen for 60% of our patients, with one-third suffering from feeding intolerance.…”

Section: Discussionsupporting

confidence: 94%

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study

et al. 2023

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Background Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort. Methods The ‘French-Speaking ICU Nutritional Survey’ (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. Results During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23–2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00–1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01–1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98–1.11). Conclusions In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.

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Section: Discussionsupporting

confidence: 94%

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study

et al. 2023

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“…Studien zur Ernährungstherapie wurde in einem großen Teil der Studiengruppen der erforderliche Energiebedarf nicht erreicht [50].…”

Section: Selbst In Verschiedenen Klinischenunclassified

Enterale Ernährungstherapie in der Intensivmedizin

Höhn

Stolecki

Schröder

2015

Med Klin Intensivmed Notfmed

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Nutrition therapy is a cornerstone in critical care. Early enteral feeding in patients who are unable to meet caloric requirements from oral intake is associated with better clinical outcomes. However, there are still uncertainties about optimal timing, dose, and formula selection of enteral nutrition in critically ill patients. In the present article, an overview of current knowledge and practical strategies for successful implementation of enteral nutrition in intensive care patients is given.

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“…Moreover, no studies compared low versus standard protein intakes at the acute phase. Thus, the optimal calorie and protein intakes at the acute phase of severe critical illness remain unknown.9, 18,19 We designed the NUTRIREA-3 multicentre randomised trial to evaluate whether, in critically ill patients receiving invasive mechanical ventilation and vasoactive drugs, low-calorie low-protein feeding decreased day 90 mortality or ICU length of stay, or both parameters, compared with standard calorie and protein supplies.…”

Section: Introductionmentioning

confidence: 99%