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Tailoring nutrition therapy to illness and recovery.

Publication ,  Journal Article
Wischmeyer, PE
Published in: Crit Care
December 28, 2017

Without doubt, in medicine as in life, one size does not fit all. We do not administer the same drug or dose to every patient at all times, so why then would we live under the illusion that we should give the same nutrition at all times in the continuum of critical illness? We have long lived under the assumption that critical illness and trauma lead to a consistent early increase in metabolic/caloric need, the so-called "hypermetabolism" of critical illness. What if this is incorrect? Recent data indicate that early underfeeding of calories (trophic feeding) may have benefits and may require consideration in well-nourished patients. However, we must confront the reality that currently ICU nutrition delivery worldwide is actually leading to "starvation" of our patients and is likely a major contributor to poor long-term quality of life outcomes. To begin to ascertain the actual calorie and protein delivery required for optimal ICU recovery, an understanding of "starvation" and recovery from starvation and lean body mass (LBM) loss is needed. To begin to answer this question, we must look to the landmark Minnesota Starvation Study from 1945. This trial defines much of the world's knowledge about starvation, and most importantly what is required for recovery from starvation and massive LBM loss as occurs in the ICU. Recent and historic data indicate that critical illness is characterized by early massive catabolism, LBM loss, and escalating hypermetabolism that can persist for months or years. Early enteral nutrition during the acute phase should attempt to correct micronutrient/vitamin deficiencies, deliver adequate protein, and moderate nonprotein calories in well-nourished patients, as in the acute phase they are capable of generating significant endogenous energy. Post resuscitation, increasing protein (1.5-2.0 g/kg/day) and calories are needed to attenuate LBM loss and promote recovery. Malnutrition screening is essential and parenteral nutrition can be safely added following resuscitation when enteral nutrition is failing based on pre-illness malnutrition and LBM status. Following the ICU stay, significant protein/calorie delivery for months or years is required to facilitate functional and LBM recovery, with high-protein oral supplements being essential to achieve adequate nutrition.

Duke Scholars

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Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

December 28, 2017

Volume

21

Issue

Suppl 3

Start / End Page

316

Location

England

Related Subject Headings

  • World War II
  • Warfare
  • Research Design
  • Precision Medicine
  • Nutritional Support
  • Nutritional Status
  • Muscle Strength
  • Humans
  • History, 20th Century
  • Fatigue
 

Citation

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ICMJE
MLA
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Wischmeyer, P. E. (2017). Tailoring nutrition therapy to illness and recovery. Crit Care, 21(Suppl 3), 316. https://doi.org/10.1186/s13054-017-1906-8
Wischmeyer, Paul E. “Tailoring nutrition therapy to illness and recovery.Crit Care 21, no. Suppl 3 (December 28, 2017): 316. https://doi.org/10.1186/s13054-017-1906-8.
Wischmeyer PE. Tailoring nutrition therapy to illness and recovery. Crit Care. 2017 Dec 28;21(Suppl 3):316.
Wischmeyer, Paul E. “Tailoring nutrition therapy to illness and recovery.Crit Care, vol. 21, no. Suppl 3, Dec. 2017, p. 316. Pubmed, doi:10.1186/s13054-017-1906-8.
Wischmeyer PE. Tailoring nutrition therapy to illness and recovery. Crit Care. 2017 Dec 28;21(Suppl 3):316.

Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

December 28, 2017

Volume

21

Issue

Suppl 3

Start / End Page

316

Location

England

Related Subject Headings

  • World War II
  • Warfare
  • Research Design
  • Precision Medicine
  • Nutritional Support
  • Nutritional Status
  • Muscle Strength
  • Humans
  • History, 20th Century
  • Fatigue