How to feed the critically ill – Dr James Day

Why is hypocaloric feeding better- Casear

Doesn’t kill nor saves lives

May avoid infections and enhance recovery

Doesn’t compromise recovery

Reduction of ICU acquired weakness

Early nutrient restriction and hypocalorific feeding are harmless and may enhance recovery

Early nutrient restriction avoids early suppression of autophagy in skeletal muscle

The optimal duration of nutrient restriction and role of different macro nutrients needs to be further eleucidated

Should autophagy be respected or activated?

 

References

EPaNIC Study

Review: Timing of PN

CALORIES trial

 

Feeding and Chronically Critically ill-Guttormsem

What does chronically critically ill mean:

  • Presence of tracheostomy
  • On ICU>7 days

Unresolved issues:

  • How much energy to give?
  • Hypocaloric or isocalorific- different targets in different phases of the ICU/hospital stay

How much protein to give- need to see energy, protein and muscle as unity.

Is it possible to identify the critically ill patient at nutritional deficiency?

Energy demands may double in the rehabilitation phase of critical illness. They are back on the ward then.

When pt out of bed (i.e. rehabilitation phase) feed to put on weight (muscle mass)

 

References:

The evolution of nutrition in critical care: how much, how soon?