by Pierre Singer
Abstract
Critically ill patients require adequate nutritional support
to meet energy requirements both during and after intensive care unit (ICU)
stay to protect against severe catabolism and prevent significant
deconditioning. ICU patients often suffer from chronic critical illness causing
an increase in energy expenditure, leading to proteolysis and related muscle
loss. Careful supplementation and modulation of caloric and protein intake can
avoid under- or overfeeding, both associated with poorer outcomes. Indirect
calorimetry is the preferred method for assessing resting energy expenditure
and the appropriate caloric and protein intake to counter energy and muscle
loss. Physical exercise may have favorable effects on muscle preservation and
should be considered even early in the hospital course of a critically ill
patient. After liberation from the ventilator or during non-invasive
ventilation, oral intake should be carefully evaluated and, in case of severe
dysphagia, should be avoided and replaced by enteral of parenteral nutrition.
Upon transfer from the ICU to the ward, adequate nutrition remains essential
for long-term rehabilitation success and continued emphasis on sufficient
nutritional supplementation in the ward is necessary to avoid a suboptimal
nutritional state.
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