Critical Care

The role of nutrition in critical care

Nutritional support, which is integrated in the disease management of critically ill patients, has been shown to improve clinical outcomes such as reducing (infectious) complications, hospital length of stay and even mortality.1,2 If normal oral intake is not possible, early enteral nutrition, (within 48 hours) by means of oral nutrition supplements or tube feeding is preferred above parenteral nutrition. 3,4

There has been scientific progress in the field of medical nutrition, and now there is a better understanding of optimal feeding in the critical care setting2 ,5, 6, 7, 8,9. Both clinical nutrition guidelines and ICU experts have recognised the need for a new, individualised approach to nutritional care10, 11, 12, 13, 14.

For surgical patients it is important to reduce the period of starvation just before and after surgery, to prevent inadequate nutrient intake days before and after surgery and to modify the metabolic response to surgical stress. For intensive care unit (ICU) patients it is important to target the right amount of energy and protein intake without overfeeding the patient. For both surgical and ICU patients, there is the challenge to deal with the disease-related compromised gut. Immunonutrition for ICU patients has long been considered to bring additional medical benefits, however most recent guidelines have changed towards not recommending high dosage of immune-modulating nutrients. Immune-modulating nutrients refers to nutrients that aim to alter the immune response.

“The significance of nutrition in the hospital setting (especially the ICU) cannot be overstated.”

SCCM & ASPEN Guidelines15

Society of Critical Care Medicine & American Society for Parenteral and Enteral Nutrition

1.
Weimann et al. Espen guideline, Clinical nutrition in surgery. Clinical Nutrition 2017.
2.
Doig GS et al. 2009.
3.
McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA et al: Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN Journal of parenteral and enteral nutrition 2016, 40(2):159-211.
4.
ESPEN Guidelines on Enteral Nutrition: Intensive care. Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, Nitenberg G, van den Berghe G, Wernerman J; DGEM (German Society for Nutritional Medicine), Ebner C, Hartl W, Heymann C, Spies C; ESPEN (European Society for Parenteral and Enteral Nutrition). Clin Nutr. 2006 Apr;25(2):210-23. Epub 2006 May 11. .
5.
Casaer MP et al. 2011.
6.
Van Zanten AR et al. 2014.
7.
Weijs et al. 2014.
8.
Allingstrup M J et al. 2012.
9.
Elke G et al. 2014.
10.
McClave S et al. 2009.
11.
Dhaliwal R et al. 2014.
12.
Martindale RG 2015.
13.
Evans DC et al. 2015.
14.
Preiser JC. et al. 2015.
15.
Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).