Prospective observational cohort study of reached protein and energy targets in general wards during the post-intensive care period: The PROSPECT-I study

Slingerland-Boot, Rianne; Heijden, Ino van der; Schouten, Nienke; Driessen, Luuk; Meijer, Sjoerd; Mensink, Marco; Zanten, Arthur R. H. van

doi:10.1016/j.clnu.2022.07.031

Cited by 11 publications

(9 citation statements)

References 26 publications

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“…In a recent cohort study, energy and protein deficits during the hospitalization period were reported in ICU patients admitted with a traumatic brain injury 30 . Two other cohort studies showed patients did not meet estimated or measured energy and protein requirements in the general ward after ICU discharge, whereas patients receiving an OD were the most at risk 31,32 . Our study adds to the sparse body of post‐ICU data, demonstrating that, in a significant proportion of ICU patients, nutrition intake is inadequate for up to 12 months after admission.…”

Section: Discussionmentioning

confidence: 65%

“…30 Two other cohort studies showed patients did not meet estimated or measured energy and protein requirements in the general ward after ICU discharge, whereas patients receiving an OD were the most at risk. 31,32 Our study adds to the sparse body of post-ICU data, demonstrating that, in a significant proportion of ICU patients, nutrition intake is inadequate for up to 12 months after admission. Nevertheless, the impact of deficits during the post-ICU period remains unclear…”

Section: Discussionmentioning

confidence: 86%

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Protein and energy intake in intensive care unit survivors during the first year of recovery: A descriptive cohort study

Beumeler,

Visser,

Buter

et al. 2023

J Parenter Enteral Nutr

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PurposeMany ICU survivors suffer long‐term health issues, affecting their quality of life. Nutritional inadequacy can limit their rehabilitation potential. This study investigates nutritional intake and support during ICU admission and recovery.MethodsIn this prospective cohort study, 81 adult ICU patients with stays ≥ 48 hours were included. Data on dietary intake, feeding strategies, baseline/ICU characteristics, and one‐year outcomes (physical health and readmission rates) were collected. The number of patients achieving 1.2 g/kg/d protein and 25 kcal/kg/d at 3, 6, and 12 months post‐ICU was recorded. The impact of dietary supplementation during the year was assessed. Baseline characteristics, intake barriers, and rehabilitation's influence on nutritional intake at 12 months were evaluated, along with inadequate intake's effect on outcomes.ResultsAfter 12 months, only 10% of 60 patients achieved 1.2 g/kg/d protein intake, while 28% reached the advised 25 kcal/kg/d energy target. Supplementary feeding significantly increased protein intake at 3, 6, and 12 months (p=0.003, p=0.012, p=0.033) and energy intake at 3 months (p=0.003). A positive correlation was found between female sex and energy intake at 12 months post‐ICU (β=4.145, p=0.043), and taste issues independently associated with higher protein intake (β=0.363, p=0.036). However, achieving upper quartile protein or energy intake did not translate into improved physical health outcomes.ConclusionThis study shows that protein and energy intake is below recommendations in the majority of ICU survivors during the first year of recovery. Continuous and improved nutritional care is urgently needed to support patients in reaching nutritional adequacy.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 86%

Protein and energy intake in intensive care unit survivors during the first year of recovery: A descriptive cohort study

Beumeler,

Visser,

Buter

et al. 2023

J Parenter Enteral Nutr

View full text Add to dashboard Cite

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“…The administration route plays an important role; oral nutrition is typically revealed to be highly inadequate, which is very relevant but often overlooked clinical information. Oral nutritional supplements, enteral nutrition, and parenteral nutrition are critical factors in increasing feeding adequacy [6 ▪▪ ]. Different barriers to adequate nutrition post-ICU have already been well identified [9 ▪▪ ], both physiological and functional.…”

Section: Discussionmentioning

confidence: 99%

“…The PROSPECT-1 study revealed that most patients did not meet energy and protein targets in the post-ICU hospitalization period, but a result of 82% for energy and 83% for protein adequacy is high in contrast to other publications; an Australian dataset showed numbers of 79 and 73%, and the Wittholz data were 64% and 72% for energy and protein, respectively, all of this being discussed in the review of Slingerland-Boot et al [6 ▪▪ ].…”

Section: How Are Icu Survivors Fed?mentioning

confidence: 94%

Post-ICU nutrition: the neglected side of metabolic support

Waele

Rosseel

Pen

2023

Current Opinion in Critical Care

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Purpose of this review This review will focus on the neglected side of metabolic support in ICU survivors: nutritional therapy after critical illness. Knowledge of the evolution of the metabolism of patients that survived critical illness will be bundled, and current practices will be investigated. We will discuss some studies conducted to determine resting energy expenditure in ICU survivors and which identified barriers that cause interruptions in the feeding process based on published data between January 2022 and April 2023. Recent findings Resting energy expenditure can be measured using indirect calorimetry, as predictive equations have proven to fail in their attempt to have good correlations with measured values. No guidelines or recommendations are available on post-ICU follow-up, including screening, assessment, dosing, timing, and monitoring of (artificial) nutrition. A limited number of publications shared treatment adequacy between 64–82% for energy (calories) and 72–83% for protein intake in a post-ICU setting. Loss of appetite, depression, and oropharyngeal dysphagia are the most prominent physiological barriers responsible for decreased feeding adequacy. Summary Patients may be in a catabolic state during and after ICU discharge, with several factors impacting metabolism. Therefore, large prospective trials are needed to determine the physiological state of ICU survivors, determine nutritional requirements, and develop nutritional care protocols. Many barriers causing decreased feeding adequacy have already been identified, but solutions are scarce. This review depicts a variable metabolic rate among ICU survivors and a significant variation in feeding adequacy in-between world regions, institutions, and patient sub-phenotypes.

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“…In the PROSPECT-I study, Slingerland-Boot et al [46 ▪ ] showed that removal of the nasogastric tube leads to an immediate decrease in daily energy (44.1%) and protein (50.7%) intake, suggesting that EN tapering protocols and introduction of ONS after tube removal are essential to optimize nutritional intake during ICU recovery. The causes of inadequate intake should be evaluated.…”

Section: Post-icu Nutritionmentioning

confidence: 99%

Current insights in ICU nutrition: tailored nutrition

Hermans

Laarhuis²,

Kouw

et al. 2023

Current Opinion in Critical Care

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Purpose of reviewTo summarize recent research on critical care nutrition focusing on the optimal composition, timing, and monitoring of enteral feeding strategies for (post)-ICU patients. We provide new insights on energy and protein recommendations, feeding intolerance, and describe nutritional practices for coronavirus disease 2019 ICU patients.Recent findingsThe use of indirect calorimetry to establish individual energy requirements for ICU patients is considered the gold standard. The limited research on optimal feeding targets in the early phase of critical illness suggests avoiding overfeeding. Protein provision based upon the absolute lean body mass is rational. Therefore, body composition measurements should be considered. Body impedance analysis and muscle ultrasound seem reliable, affordable, and accessible methods to assess body composition at the bedside. There is inadequate evidence to change our practice of continuous enteral feeding into intermittent feeding. Finally, severe acute respiratory syndrome coronavirus 2 patients are prone to underfeeding due to hypermetabolism and should be closely monitored.SummaryNutritional therapy should be adapted to the patient's characteristics, diagnosis, and state of metabolism during ICU stay and convalescence. A personalized nutrition plan may prevent harmful over- or underfeeding and attenuate muscle loss. Despite novel insights, more research is warranted into tailored nutrition strategies during critical illness and convalescence.

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Prospective observational cohort study of reached protein and energy targets in general wards during the post-intensive care period: The PROSPECT-I study

Cited by 11 publications

References 26 publications

Protein and energy intake in intensive care unit survivors during the first year of recovery: A descriptive cohort study

Protein and energy intake in intensive care unit survivors during the first year of recovery: A descriptive cohort study

Post-ICU nutrition: the neglected side of metabolic support

Current insights in ICU nutrition: tailored nutrition

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