Nutritional issues concerning general medical ward patients: feeding patients recovering from critical illness

Abstract

Purpose of reviewICU survivors often spend long periods of time in general wards following transfer from ICU in which they are still nutritionally compromised. This brief review will focus on the feeding of patients recovering from critical illness, as no formal recommendations or guidelines on nutrition management are available for this specific situation.Recent findingsWhile feeding should start in the ICU, it is important to continue and adapt nutritional plans on the ward to support individuals recovering from critical illness. This process is highly complex – suboptimal feeding may contribute significantly to higher morbidity and mortality, and seriously hinder recovery from illness. Recently, consensus diagnostic criteria for malnutrition have been defined and large-scale trials have advanced our understanding of the pathophysiological pathways underlying malnutrition. They have also helped further develop treatment algorithms. However, we must continue to identify specific clinical parameters and blood biomarkers to further personalize therapy for malnourished patients. Better understanding of such factors may help us adapt nutritional plans more efficiently.SummaryAdequate nutrition is a vigorous component of treatment in the post-ICU period and can enhance recovery and improve clinical outcome. To better personalize nutritional treatment because not every patient benefits from support in the same manner, it is important to further investigate biomarkers with a possible prognostic value.

Inflammation and response to nutrition interventions

“…Disease-related malnutrition (DRM) is a multifactorial complex syndrome that is negatively affected by disease-related systemic inflammatory response, 18 contributes to high morbidity and mortality, 19,20 and seriously interferes with recovery from acute illness. 21 In industrialized countries, malnutrition is mainly diseaserelated and its relevance is reflected by its prevalence. Data from Europe and the United States demonstrate that about 30% of patients have malnutrition or are at risk at hospital admission.…”

“…These patients are severely ill and often are unable to feed volitionally by mouth for periods up to weeks. 21 The catabolic response is much more pronounced than that evoked by fasting in healthy persons, since the energy deficit in acutely ill patients is often superimposed on immobilization and pronounced inflammatory and endocrine stress response. 33 Even after ICU discharge, the majority of patients remain nutritionally compromised and oral intake of food continues to be hampered by various barriers like low appetite, taste changes, impaired swallow function, gastrointestinal disturbances, or psychosocial factors.…”

“…Herein, a highly vulnerable population are patients treated in intensive care units (ICUs). These patients are severely ill and often are unable to feed volitionally by mouth for periods up to weeks 21 . The catabolic response is much more pronounced than that evoked by fasting in healthy persons, since the energy deficit in acutely ill patients is often superimposed on immobilization and pronounced inflammatory and endocrine stress response 33 .…”

Editorial: The interaction between protein delivery and blood urea and ammonia during critical illness

“…While the large trials listed above will provide crucial population level insights to inform practice, there should be parallel and ongoing work to understand how to optimize nutritional therapy for the individual [18]. Studies evaluating the mechanisms underlying rapid muscle wasting and weakness during critical illness, population effects of augmenting dietary protein during the recovery phase and the interaction between protein and exercise are also warranted [19,20]. Finally, further work to understand whether the type of amino acid matters, with leucine (or its metabolite beta-hydroxy-betamethylbutyrate, HMB) or glycine, representing candidate amino acids that merit further evaluation [5,21,22].…”