Pragmatic approach to nutrition in the ICU: expert opinion regarding which calorie protein target

Pierre Singer, Michael Hiesmayr, Gianni Biolo, Thomas W Felbinger, Mette M Berger, Christiane Goeters, Jens Kondrup, Christian Wunder, Claude Pichard
Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition 2014, 33 (2): 246-51

BACKGROUND & AIMS: Since the publications of the ESPEN guidelines on enteral and parenteral nutrition in ICU, numerous studies have added information to assist the nutritional management of critically ill patients regarding the recognition of the right population to feed, the energy-protein targeting, the route and the timing to start.

METHODS: We reviewed and discussed the literature related to nutrition in the ICU from 2006 until October 2013.

RESULTS: To identify safe, minimal and maximal amounts for the different nutrients and at the different stages of the acute illness is necessary. These amounts might be specific for different phases in the time course of the patient's illness. The best approach is to target the energy goal defined by indirect calorimetry. High protein intake (1.5 g/kg/d) is recommended during the early phase of the ICU stay, regardless of the simultaneous calorie intake. This recommendation can reduce catabolism. Later on, high protein intake remains recommended, likely combined with a sufficient amount of energy to avoid proteolysis.

CONCLUSIONS: Pragmatic recommendations are proposed to practically optimize nutritional therapy based on recent publications. However, on some issues, there is insufficient evidence to make expert recommendations.

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