The truth about nutrition in the ICU

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

“…In addition, the studies have not been stratified according to age, presence, and severity of malnutrition/ obesity or timing of administration. What is required are studies comparing outcomes of patients receiving a nutrition regimen according to guidelines with the ''facts on the ground'' [10], i.e., low calorie and protein intakes, for instance those derived from the Nutrition Day ICU audits. No true conclusions or strong recommendations will be possible without this step.…”

Focus on nutrition

“…The strongest evidence identified by the early 2015 review paper was related to early enteral nutrition starting [1] and this concept was confirmed by Reigner et al in a post-marginal structural model study on the impact of early nutrition on outcome of ventilated patients in shock [2], a topic in active debate. In 3032 patients in shock, early enteral or parenteral nutrition commenced within 48 h after intubation was associated with reduced mortality.…”

“…"The truth on nutrition in the ICU" [1], published early last year, identified a number of basic truths about nutrition support that were supported by evidence. Many of these truths have been confirmed in the most recent publications during 2015 related to nutrition in the intensive care.…”

“…Perhaps the most controversial expert recommendation is that patients with a normal BMI who cannot receive enteral nutrition (EN) or oral intake can be starved for 7 days. The recommendation to withhold parenteral nutrition over the first 7 days following ICU admission if early enteral nutrition is not feasible contradicts evidence from large-scale randomized controlled trials (RCTs) that demonstrate that early parenteral nutrition (PN) preserves muscle mass, shortens the duration of mechanical ventilation, and improves quality of life post-ICU discharge [1]. Indeed, after the publications of the CALORIES [5] study showing no harm related to PN in ICU patients, unfounded biases regarding the detrimental effect of early PN must be reconsidered together with the amount of calories administered [1].…”

“…The recommendation to withhold parenteral nutrition over the first 7 days following ICU admission if early enteral nutrition is not feasible contradicts evidence from large-scale randomized controlled trials (RCTs) that demonstrate that early parenteral nutrition (PN) preserves muscle mass, shortens the duration of mechanical ventilation, and improves quality of life post-ICU discharge [1]. Indeed, after the publications of the CALORIES [5] study showing no harm related to PN in ICU patients, unfounded biases regarding the detrimental effect of early PN must be reconsidered together with the amount of calories administered [1]. Elke et al [6], in a review of the literature, compared PN to EN when the calories administered were similar and could not find any difference in terms of morbidity and mortality.…”