Energy and nutrient requirements in the intensive care unit inpatients: A narrative review
Background: Malnutrition has been the most prevalent problem in hospitalized patients during recent years, which accentuate the paramount importance of comprehensive nutritional support among these patients. This study aimed to provide a review of the recent literature about intensive care unit (ICU) inpatients and their nutritional care.
Methods: This review on energy and nutrient requirements for feeding the ICU inpatients focused on literature in English language. An on-line search using the keywords “nutritional support, malnutrition, ICU inpatients, micronutrient deficiencies, critically ill” in ISI web of science, PubMed, Scopus journals published during the years (June 1979-November 2014) was run. The cross- sectional and prospective studies, as well as the clinical trials, were recruited into this investigation.
Results: Recent studies propose energy provision with 20-25 Kcal/Kg/day or 25-35 Kcal/Kg/day for critically ill patients. The recommended carbohydrate and protein intakes are 2-4 g/Kg/day, 1.2-1.5 g/Kg/day, respectively. The suggested fat intake is 25-30% of a total calorie. The latest studies stressed the need for antioxidant vitamins and trace elements such as A, C, β-carotene, E, selenium, magnesium and zinc among ICU inpatients.
Conclusion: High prevalence of malnutrition among ICU inpatients caution to provide a nutritional health care team, including professionals and dietitians who evaluate the effectiveness of treatment and supplementations. Energy requirement should be determined according to their nutritional and clinical status; then macro and micronutrient needs should be considered for ICU inpatients.
Chowdary KV, Reddy PN. Parenteral nutrition: Revisited. Indian J Anaesth. 2010; 54(2): 95-103.
Lim SH, Lee JS, Chae SH, Ahn BS, Chang DJ, Shin CS. Prealbumin is not sensitive indicator of nutrition and prognosis in critical ill patients. Yonsei Med J. 2005; 46(1): 21-6.
Desai SV, McClave SA, Rice TW. Nutrition in 231-7.; the ICU: an evidence-based approach. Chest.2014; 145(5): 1148-5
Umali MN, Llido LO, Francisco EM, Sioson MS, Gutierrez EC, Navarrette EG, et al. Recommended and actual calorie intake of intensive care unit patients in a private tertiary care hospital in the Philippines. Nutrition. 2006;22(4): 345-9.
Bengmark S. Nutrition of the critically ill — a 21st-century perspective. Nutrients.2013; 5(1): 162-207.
Dehnadi Moghadam A, Yousefzade Chabok Sh, Ramezani F, Kazemnejd Leili E, Rahimi V. Evaluation of nutritional quality and microbial contamination of enteral feeding solutions in hospitalized patients referred to neurosurgical ICU of Poursina Hospital in Rasht. Pejouhandeh.2010; 15(5): 213-9. [In Persian].
Kathiresan AS, Brookfield KF, Schuman SI, Lucci JA, III. Malnutrition as a predictor of poor postoperative outcomes in gynecologic cancer patients. Arch Gynecol Obstet. 2011;284(2):445-51.
Laky B, Janda M, Bauer J, Vavra C, Cleghorn G, Obermair A. Malnutrition among gynaecological cancer patients. Eur J Clin Nutr. 2007; 61(5):642-6.
Merritt RJ, Suskind RM. Nutritional survey of hospitalized pediatric patients. Am J Clin Nutr.1979; 32(6): 1320-5.
Pollack MM, Wiley JS, Holbrook PR. Early nutritional depletion in critically ill children. Crit Care Med. 1981; 9(8): 580-3.
Pollack MM, Wiley JS, Kanter R, Holbrook PR.Malnutrition in critically ill infants and children. JPEN J Parenter Enteral Nutr. 1982; 6(1): 20-4.
Lee S, Choi M, Kim Y, Lee J, Shin C.Nosocomial infection of malnourished patients in an intensive care unit. Yonsei Med J. 2003; 44(2):203-9.
Kim H, Choi-Kwon S. Changes in nutritional status in ICU patients receiving enteral tube feeding: a prospective descriptive study. Intensive Crit Care Nurs. 2011; 27(4): 194-201.
Thibault R, Pichard C. Parenteral nutrition in critical illness: can it safely improve outcomes? Crit Care Clin. 2010; 26(3): 467-80, viii.
Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux RNM, Delarue J, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr. 2005; 24(4): 502-9.
Kalantari H, Barekat SM, Maracy MR, Azadbakht L, Shahshahan Z. Nutritional status in patients with ulcerative colitis in Isfahan, Iran. Adv Biomed Res. 2014; 3: 58.
Krishnan JA, Parce PB, Martinez A, Diette GB,Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest. 2003.124(1): 297-305.
Turner P. Providing optimal nutritional support on the intensive care unit: key challenges and practical solutions. Proc Nutr Soc. 2010; 69(4):574-81.
van Schijndel RJ, de Groot SD, Driessen RH, Ligthart-Melis G, Girbes AR, Beishuizen A, et al. Computer-aided support improves early and adequate delivery of nutrients in the ICU. Neth J Med. 2009; 67(11): 388-93.
Reid MB, Allard-Gould P. Malnutrition and the critically ill elderly patient. Crit Care Nurs Clin North Am. 2004; 16(4): 531-6.
Cahill NE, Murch L, Cook D, Heyland DK.Improving the provision of enteral nutrition in the intensive care unit: a description of a multifaceted intervention tailored to overcome local barriers. Nutr Clin Pract. 2014; 29(1): 110-7.
Casaer MP, Langouche L, Coudyzer W, Vanbeckevoort D, De DB, Guiza FG, et al. Impact of early parenteral nutrition on muscle and adipose tissue compartments during critical illness. Crit Care Med. 2013; 41(10): 2298-309.
Dobson K, Scott A. Review of ICU nutrition support practices: implementing the nurse-led enteral feeding algorithm. Nurs Crit Care. 2007;12(3): 114-23.
Scurlock C, Mechanick JI. Early nutrition support in the intensive care unit: a US perspective. Curr Opin Clin Nutr Metab Care. 2008; 11(2): 152-5.
Doig GS, Simpson F, Sweetman EA, Finfer SR, Cooper DJ, Heighes PT, et al. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. JAMA.2013; 309(20): 2130-8.
Bonet SA, Marquez Vacaro JA, Seron AC.Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: macronutrient and micronutrient requirements. Nutr Hosp. 2011; 26(Suppl 2): 16-20.
Singer P, Anbar R, Cohen J, Shapiro H, Shalita- Chesner M, Lev S, et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med. 2011;37(4): 601-9.
Casaer MP, Van den Berghe G. Nutrition in the acute phase of critical illness. N Engl J Med.2014; 370(13): 1227-36.
Wischmeyer PE. The evolution of nutrition in critical care: how much, how soon? Crit Care.2013; 17(Suppl 1): S7.
Young AM, Kidston S, Banks MD, Mudge AM, Isenring EA. Malnutrition screening tools: comparison against two validated nutrition assessment methods in older medical inpatients. Nutrition. 2013; 29(1): 101-6.
Genton L, Pichard C. Protein catabolism and requirements in severe illness. Int J Vitam Nutr Res. 2011; 81(2-3): 143-52.
DeLegge MH. Nutrition support in the intensive care patient. J Infus Nurs. 2013; 36(4): 262-8.
Drover JW, Cahill NE, Kutsogiannis J, Pagliarello G, Wischmeyer P, Wang M, et al. Nutrition therapy for the critically ill surgical patient: we need to do better! JPEN J Parenter Enteral Nutr. 2010; 34(6): 644-52.
Soguel L, Revelly JP, Schaller MD, Longchamp C, Berger MM. Energy deficit and length of hospital stay can be reduced by a two-step quality improvement of nutrition therapy: the intensive care unit dietitian can make the difference. Crit Care Med. 2012; 40(2): 412-9.
Taha AA, Badr L, Westlake C, Dee V, Mudit M, Tiras KL. Effect of early nutritional support on intensive care unit length of stay and neurological status at discharge in children with severe traumatic brain injury. J Neurosci Nurs. 2011;43(6): 291-7.
Seron AC, Zamora EM, Labarta ML, Garrido Ramirez dA, I, Lander AA, Marquina Lacueva MI, et al. Nutritional support outcomes in critical care. Nutr Hosp. 2011; 26(6): 1469-77.
Arabi YM, Haddad SH, Tamim HM, Rishu AH, Sakkijha MH, Kahoul SH, et al. Near-target caloric intake in critically ill medical-surgical patients is associated with adverse outcomes. JPEN J Parenter Enteral Nutr. 2010; 34(3): 280-8.
Felbinger TW, Hecker M, Elke G. Nutrition of the critically ill - is less more? How much energy for the ICU patient?. Anasthesiol Intensivmed Notfallmed Schmerzther. 2014; 49(2): 114-21.
Singer P, Hiesmayr M, Biolo G, Felbinger TW, Berger MM, Goeters C, et al. Pragmatic approach to nutrition in the ICU: expert opinion regarding which calorie protein target. Clin Nutr. 2014;33(2): 246-51.
Charlton MR. Branched chains revisited.Gastroenterology. 1996; 111(1): 252-5.
Hecker M, Weigand MA, Mayer K. Nutrition of intensive care patients - how to reach target parameters. Anasthesiol Intensivmed Notfallmed Schmerzther. 2014; 49(2): 106-12.
Roth E, Kudsk KA. Immunonutrition: back to science. JPEN J Parenter Enteral Nutr. 2004;28(4): 278-80.
Mercadal OG, Llop Talaveron JM. Effectiveness of perioperative glutamine in parenteral nutrition in patients at risk of moderate to severe malnutrition. Nutr Hosp. 2011; 26(6): 1305-12.
Chen W, Jiang H, Zhou ZY, Tao YX, Cai B, Liu J, et al. Is omega-3 fatty acids enriched nutrition support safe for critical ill patients? A systematic review and meta-analysis. Nutrients. 2014;6(6):2148-64.
Hardy G, Hardy I, Manzanares W. Selenium supplementation in the critically ill. Nutr Clin Pract. 2012; 27(1):21-33 .
|Issue||Vol 1, No 2 (spring 2015)|
|Intensive care unit inpatients Nutritional support Nutrient requirements Critical illness|
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