(Mal)nutrition in critical illness and beyond: a narrative review

Summary Close liaison with ICU‐trained dietitians and early initiation of nutrition is a fundamental principle of care of critically ill patients– this should be done while monitoring closely for refeeding syndrome. Enteral nutrition delivered by volumetric pumps should be used where possible, thoug...

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Bibliographic Details
Published in:Anaesthesia 2023-06, Vol.78 (6), p.770-778
Main Authors: Pohlenz‐Saw, J. A. E., Merriweather, J. L., Wandrag, L.
Format: Article
Language:English
Subjects:
Amino acids
Complications
Critical Care
critical illness
Critical Illness - therapy
Enteral Nutrition
Guidelines
Humans
intensive care unit
Intensive Care Units
Intolerance
Malnutrition
Malnutrition - therapy
Muscles
Nutrient solutions
Nutrition
Nutritional Status
Parenteral nutrition
Patient-centered care
Proteins
Risk factors
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Summary:Summary Close liaison with ICU‐trained dietitians and early initiation of nutrition is a fundamental principle of care of critically ill patients– this should be done while monitoring closely for refeeding syndrome. Enteral nutrition delivered by volumetric pumps should be used where possible, though parenteral nutrition should be started early in patients with high nutritional risk factors. Malnutrition and loss of muscle mass are common in patients who are admitted to ICUs and are prognostic for patient‐centred outcomes including complications and mortality. Obesity is part of that story, and isocaloric and high‐protein provision of nutrition is important in this group of patients who comprise a growing proportion of people treated. Assessing protein stores and appropriate dosing is, however, challenging in all groups of patients. It would be beneficial to develop strategies to reduce muscle wasting as well; various strategies including amino acid supplementation, ketogenic nutrition and exercise have been trialled, but the quality of data has been inadequate to address this phenomenon. Nutritional targets are rarely achieved in practice, and all ICUs should incorporate clear guidelines to help address this. These should include local nutritional and fasting guidelines and for the management of feed intolerance, early access to post‐pyloric feeding and a multidisciplinary framework to support the importance of nutritional education.
ISSN:0003-2409
1365-2044
DOI:10.1111/anae.15951