Point-Counterpoint: Indirect Calorimetry Is Essential for Optimal Nutrition Therapy in the Intensive Care Unit.
COVID-19
/ complications
Calorimetry, Indirect
/ methods
Critical Care
/ methods
Critical Care Outcomes
Critical Illness
/ therapy
Energy Metabolism
Humans
Intensive Care Units
Malnutrition
/ diagnosis
Nutrition Assessment
Nutrition Therapy
/ methods
Nutritional Requirements
Nutritional Status
SARS-CoV-2
critical illness
energy expenditure
indirect calorimetry
intensive care unit
malnutrition
nutrition support
Journal
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
ISSN: 1941-2452
Titre abrégé: Nutr Clin Pract
Pays: United States
ID NLM: 8606733
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
pubmed:
19
3
2021
medline:
28
4
2021
entrez:
18
3
2021
Statut:
ppublish
Résumé
Iatrogenic malnutrition and underfeeding are ubiquitous in intensive care units (ICUs) worldwide for prolonged periods after ICU admission. A major driver leading to the lack of emphasis on timely ICU nutrition delivery is lack of objective data to guide nutrition care. If we are to ultimately overcome current fundamental challenges to effective ICU nutrition delivery, we must all adopt routine objective, longitudinal measurement of energy targets via indirect calorimetry (IC). Key evidence supporting the routine use of IC in the ICU includes (1) universal societal ICU nutrition guidelines recommending IC to determine energy requirements; (2) data showing predictive equations or body weight calculations that are consistently inaccurate and correlate poorly with measured energy expenditure, ultimately leading to routine overfeeding and underfeeding, which are both associated with poor ICU outcomes; (3) recent development and worldwide availability of a new validated, accurate, easy-to-use IC device; and (4) recent data in ICU patients with coronavirus disease 2019 (COVID-19) showing progressive hypermetabolism throughout ICU stay, emphasizing the inaccuracy of predictive equations and marked day-to-day variability in nutrition needs. Thus, given the availability of a new validated IC device, these findings emphasize that routine longitudinal IC measures should be considered the new standard of care for ICU and post-ICU nutrition delivery. As we would not deliver vasopressors without accurate blood pressure measurements, the ICU community is only likely to embrace an increased focus on the importance of early nutrition delivery when we can consistently provide objective IC measures to ensure personalized nutrition care delivers the right nutrition dose, in the right patient, at the right time to optimize clinical outcomes.
Identifiants
pubmed: 33734477
doi: 10.1002/ncp.10643
pmc: PMC8276639
mid: NIHMS1709377
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
275-281Subventions
Organisme : NHLBI NIH HHS
ID : R34 HL109369
Pays : United States
Informations de copyright
© 2021 American Society for Parenteral and Enteral Nutrition.
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