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Metabolic and nutritional support of critically ill patients: consensus and controversies

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Abstract

The results of recent large-scale clinical trials have led us to review our understanding of the metabolic response to stress and the most appropriate means of managing nutrition in critically ill patients. This review presents an update in this field, identifying and discussing a number of areas for which consensus has been reached and others where controversy remains and presenting areas for future research. We discuss optimal calorie and protein intake, the incidence and management of re-feeding syndrome, the role of gastric residual volume monitoring, the place of supplemental parenteral nutrition when enteral feeding is deemed insufficient, the role of indirect calorimetry, and potential indications for several pharmaconutrients.

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Abbreviations

EE:

Energy expenditure

EEN:

Early enteral nutrition

EPaNIC:

Impact of early parenteral nutrition completing enteral nutrition in adult critically ill patients

GRV:

Gastric residual volume

IIT:

Intensive insulin therapy

NO:

Nitric oxide

RCT:

Randomized controlled trial

REDOXS:

Reducing deaths due to oxidative stress

ROS:

Reactive oxygen species

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Authors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 808 route de Lennik, Brussels, 1070, Belgium

    Jean-Charles Preiser & Jean-Louis Vincent

  2. Department of Intensive Care, Gelderse Vallei Hospital, Willy Brandtlaan 10, Ede, Gld 6716RP, The Netherlands

    Arthur RH van Zanten

  3. Service de Médecine Intensive Adulte et Brûlés, CHUV BH 08.612, Lausanne, CH 1011, Switzerland

    Mette M Berger

  4. Department of Medical, Surgical and Health Sciences, Clinica Medica AOUTS, University of Trieste, via Farneto 3, Trieste, 34142, Italy

    Gianni Biolo

  5. Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven (UZ Leuven), Herestraat 49, Leuven, B-3000, Belgium

    Michael P Casaer & Greet Van den Berghe

  6. Northern Clinical School Intensive Care Research Unit, University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia

    Gordon S Doig

  7. Department of Medicine, University of Liverpool, Liverpool, Merseyside, L69 3BX, UK

    Richard D Griffiths

  8. Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, K7L 2 V7, Canada

    Daren K Heyland

  9. Division of Cardiac-Thoracic-Vascular Anesthesia and Intensive Care, Medical University Vienna, Spitalgasse 23, Wien, 1090, Austria

    Michael Hiesmayr

  10. Department of Anesthesiology and Intensive Care, Universita’ degli Studi di Milano, via Di Rudini’ 8, Milano, 20142, Italy

    Gaetano Iapichino

  11. Department of Clinical Medicine, Sapienza University, Piazzale Aldo Moro 5, Roma, 00185, Italy

    Alessandro Laviano

  12. Department of Nutrition, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland

    Claude Pichard

  13. Department of Intensive Care, Beilison Hospital, Petah Tikva, 49100, Israel

    Pierre Singer

  14. Department of Anesthesiology & Intensive Care Medicine, Karolinska University Hospital, Huddinge, Stockholm, 141 86, Sweden

    Jan Wernerman

  15. Department of Anesthesiology, University of Colorado School of Medicine, 12700 E. 19th Ave, Box 8602, Aurora, CO, RC2 P15-7120, USA

    Paul Wischmeyer

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  1. Jean-Charles Preiser
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  2. Arthur RH van Zanten
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  3. Mette M Berger
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  4. Gianni Biolo
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  6. Gordon S Doig
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  17. Jean-Louis Vincent
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Corresponding author

Correspondence to Jean-Charles Preiser.

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Competing interests

J-CP has received honoraria for speeches and consultancy fees from Fresenius (Bad Homburg, Germany), Nestlé (Vevey, Switzerland), Aguettant (Lyon, France), Baxter (Deerfield, IL, USA), B. Braun (Melsungen, Germany), and Nutricia (Amsterdam, The Netherlands). ARHvZ has received honoraria for speeches and consultancy fees from Abbott (North Chicago, IL, USA), Baxter, Danone (Paris, France), Fresenius, Nestlé, and Nutricia. MMB has received honoraria for lecturing from Baxter, B. Braun, Fresenius Kabi (Bad Homburg, Germany), and Nestlé. GSD has received academic research grants and consultant and speaker’s honoraria from Fresenius Kabi, Baxter Healthcare, and Nestlé Healthcare. RDG has no direct conflict of interest but has received lecture honoraria from Fresenius. DKH has received honoraria and research grants from Baxter, Fresenius Kabi, Abbott, and Nestlé Healthcare. MH has received lecture honoraria from Baxter and Fresenius and consultancy fees from Nestlé and Nutricia. Fresenius and Novo Nordisk (Bagsværd, Denmark) supported academic research partially with unrestricted grants. GI has received honoraria for speeches and consultancy fees from Abbott and Nutricia. AL has received honoraria for speeches and consultancy fees from Abbott, Baxter, B. Braun, Fresenius Kabi, Nestlé Health Science, and Nutricia and has received unrestricted educational grants from Fresenius Kabi. CP has received financial support in the form of research grants and unrestricted academic research grants, as well as non-restrictive research grants and consulting fees from Abbott, Baxter, B Braun, Cosmed (Rome, Italy), Fresenius Kabi, Nestlé Medical Nutrition, Novartis, Nutricia-Numico, Pfizer (New York, NY, USA), and Solvay (Brussels, Belgium), outside the submitted work. PS has received honoraria for lecturing and consulting fees from Baxter, B. Braun, and Fresenius Kabi AG and unrestricted research grants from B. Braun and Baxter, outside the submitted work. JW has received honoraria for speeches and consultancy fees from Baxter, Danone, Fresenius, Grifols (Barcelona, Spain), and Nestlé. PW has received research grant funding from Fresenius Kabi and GlaxoSmithKline (Brentford, UK) and honoraria for consulting and lecturing from Baxter, Abbott, Nutricia, Theravance (South San Francisco, CA, USA), and Nestlé Inc. GB, MPC, GVdB, and J-LV declare that they have no competing interests.

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Preiser, JC., van Zanten, A.R., Berger, M.M. et al. Metabolic and nutritional support of critically ill patients: consensus and controversies. Crit Care 19, 35 (2015). https://doi.org/10.1186/s13054-015-0737-8

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