Shelby Yaceczko on nutrition in critical illness + obesity (#SCCM2023)
malnourished inpatients have 3.4x risk of in-hospital death, but only 2.7% of patients with coded malnutrition actually receive enteral nutrition in the hospital.
malnourished inpatients have 3.4x risk of in-hospital death, but only 2.7% of patients with coded malnutrition actually receive enteral nutrition in the hospital.
malnutrition in ICU associated with length of stay, higher cost of care. ASPEN did a value analysis, shows nutrition support saves money (projected $222 million yearly Medicare savings).
ASPEN 2021 guidelines:
1. How much should you give? No difference between high and low levels of nutrition. Give 12-25 kcal/kg BW in first 7-10 days of ICU stay. (Old recs: depended on disease and malnutrition risk.)
1. How much should you give? No difference between high and low levels of nutrition. Give 12-25 kcal/kg BW in first 7-10 days of ICU stay. (Old recs: depended on disease and malnutrition risk.)
2. Does more protein help? No difference, but poor data. No recommendation beyond the old rec (1.2-2g/kg/day).
3. Does PN vs EN in first week of ICU make a difference (in modern era of care)? Per data, no difference. Catheter care, avoidance of overnutrition, modern formulations, etc may have changed the situation. Use what you want. Trophic feeding is theoretically nice when possible.
4. Does supplemental PN help when you can't meet goals by EN? No. Don't do it within first 7-10 days.
5. Do alternative IV lipids, eg with fish oil vs soy oil, help? Insufficient data; use what you want for lipids. Hot area, developing data.
Estimating needs: >200 formulas out there, nothing is perfect, unclear what weights to use. Indirect calorimetry remains gold standard, particularly in obese.
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