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The role of energy and nutritional support in the intensive care unit

Nature Clinical Practice Endocrinology & Metabolism volume 4, pages 378–379 (2008)Cite this article

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Critical illness is characterized by reproducible alterations in metabolism that can result in rapid loss of lean body mass and an increased risk of malnutrition. The vast majority of conditions requiring treatment in the intensive care unit (ICU) are associated with a systemic inflammatory response. As a consequence, affected individuals are generally hypermetabolic, insulin-resistant and catabolic. The magnitude of the metabolic response is proportional to the severity of both the systemic inflammatory response and the underlying illness, and is greatest in patients with major burns, trauma, and sepsis and lowest in conditions associated with muscle paresis or paralysis. Malnutrition develops in ∼43% of all critically ill, hospitalized individuals and so represents a major problem for patient care.1 The role of nutritional support in the ICU is, therefore, discussed in this Viewpoint.

The initial aim of nutritional support is to meet caloric and substrate demands in order to maintain lean body mass. Nutritional support also preserves vital organ and immune function, modulates metabolic and systemic inflammatory responses, and promotes metabolic control. As both overfeeding and underfeeding are clearly deleterious, many studies have focused on optimal levels of energy delivery. Indeed, determination of individual energy requirements is a prerequisite before nutritional support can be prescribed.

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References

  1. Reid CL (2007) Poor agreement between continuous measurements of energy expenditure and routinely used prediction equations in intensive care unit patients. Clin Nutr 26: 649–657

    Article  Google Scholar 

  2. Plank LD and Hill GL (2003) Energy balance in critical illness. Proc Nutr Soc 62: 545–552

    Article  Google Scholar 

  3. Weekes EC (2007) Controversies in the determination of energy requirements. Proc Nutr Soc 66: 367–377

    Article  Google Scholar 

  4. Villet S et al. (2005) Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 24: 502–509

    Article  Google Scholar 

  5. Caba D and Ochoa JB (2007) How many calories are necessary during critical illness? Gastrointest Endosc Clin N Am 17: 703–710

    Article  Google Scholar 

  6. Berger MM and Chioléro RL (2007) Hypocaloric feeding: pros and cons. Curr Opin Crit Care 13: 180–186

    Article  Google Scholar 

  7. Martin CM et al. (2004) Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT). CMAJ 170: 197–204

    PubMed  PubMed Central  Google Scholar 

  8. Heidegger CP et al. (2007) Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient? Intensive Care Med 33: 963–969

    Article  Google Scholar 

  9. Grau T et al. (2007) Liver dysfunction associated with artificial nutrition in critically ill patients. Crit Care 11: R10

    Article  Google Scholar 

  10. Tjader I et al. (2007) Exogenous glutamine–compensating a shortage? Crit Care Med 35 (Suppl 9): S553–S556

    Article  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Adult Intensive Care Medicine and Burns Centre, MM Berger is a Staff Intensivist and RL Chioléro is Head of the Adult Intensive Care Unit, University Hospital (CHUV), Lausanne, Switzerland.,

    Mette M Berger & René L Chioléro

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  1. Mette M Berger
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  2. René L Chioléro
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Correspondence to Mette M Berger.

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Competing interests

The authors have declared associations with the following companies: B Braun Medical (speakers bureau and grant/research support) and Fresenius Kabi (consultant, speakers bureau and grant/research support).

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Berger, M., Chioléro, R. The role of energy and nutritional support in the intensive care unit. Nat Rev Endocrinol 4, 378–379 (2008). https://doi.org/10.1038/ncpendmet0839

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