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01-09-2018 | Editorial

Optimal timing, dose and route of early nutrition therapy in critical illness and shock: the quest for the Holy Grail

Authors: Jean Reignier, Arthur R. H. Van Zanten, Yaseen M. Arabi

Published in: Intensive Care Medicine | Issue 9/2018

Excerpt

Most recent clinical practice guidelines on nutritional support in the intensive care unit (ICU) recommend that critically ill patients should receive early feeding (within 24–48 h after ICU admission), via the enteral route (enteral nutrition; EN) when feasible, and with an ultimate caloric goal of 25–30 kcal/day [1]. Meeting these conditions has been shown to be associated with reduced risk of nosocomial infectious and non-infectious complications, and also with decreased length of stay and mortality [2]. Conversely, guidelines recommend postponing or withholding early EN (EEN) in patients with hemodynamic instability [1‐3]. Indeed, these patients are at high risk of impaired splanchnic perfusion and subsequent bacterial translocation or gut ischemia [4]. However, withholding EN in patients with shock may lead to delayed EN, subsequent severe underfeeding and further reduction in barrier function. Both conditions have been shown to be associated with poor outcome. Thus, whether EEN may have beneficial or deleterious effects in patients with shock, remains highly controversial [5]. …

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Title: Optimal timing, dose and route of early nutrition therapy in critical illness and shock: the quest for the Holy Grail
Authors: Jean Reignier
Arthur R. H. Van Zanten
Yaseen M. Arabi
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 9/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5302-x

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