Energy and Protein Needs in Critical Illness - Dietetic Practice Updates
Dietitians in Nutrition SupportShow Notes
Recent studies on protein and calorie provisions for the critically ill patient have started to contrast standard recommendations, often making it confusing when calculating needs. Join Britta MS, RD, LD, CNSC as she reviews the EFFORT and NUTRIREA-3 trials and discusses considerations to be made when writing nutrition recommendations for critically ill patients based on recent literature.
Closed captions provided by: Kaitlyn Batista MS, RDN, CDN, CNSC
Timestamps: 0:19 Brief overview of newer trials 0:53 Protein needs in critical illness 2:40 EFFORT Protein Trial 7:46 NUTRIREA-3 Trial 12:08 Energy and Protein and Clinical Outcomes 13:09 ASPEN, ESPEN Guidelines and “Expert” Recommendations 15:13 Nutrition recommendations through different phases 16:38 Case Study #1 23:33 Practical Applications
References:
Heyland DK, et al. The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet. 2023;401:568-576.
Lee Z, et al. The effects of higher versus lower protein delivery in critically ill patients: an updated systemic review and meta-analysis of randomized controlled trials with trial sequential analysis. Crit Care. 2024;28:15.
Reignier J, et al. Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). Lancet Resp Med. 2023;11:602-612.
Dresen E, et al. What the clinician needs to know about medical nutrition therapy in critically ill patients in 2023: A narrative review. Nutr Clin Pract. 2023;38-479-498.
Zusman, O., Theilla, M., Cohen, J. et al. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study. Crit Care. 2016:20,367.
Compher C, Bingham AL, McCall M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. J Parenter Enteral Nutr. 2022; 46:12–41.
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, Hiesmayr M, Mayer K, Montejo JC, Pichard C, Preiser JC, van Zanten ARH, Oczkowski S, Szczeklik W, Bischoff SC. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38:48-79.
Pierre Singer, Annika Reintam Blaser, Mette M, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clinical Nutrition. 2023;42:1671-1689.
van Zanten ARH, De Waele E, Wischmeyer PE. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Crit Care. 2019;23:368.
McClave SA, Taylor BE, Martindale RG, , et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211.
More from Dietitians in Nutrition Support
Join Kelli Boi and Bridget Storm, leaders in clinical nutrition management, as they share their tips and tricks for salary negotiations and identifying opportunities for career advancement in dietetics. They include notes for first time job seekers, those looking for promotion, and team leaders who want to advocate for their teams.
Dosing protein in parenteral nutrition for patients on dialysis can be difficult. Join Rachel, MS, RD, CD, CNSC as she shares how she approaches this challenge including access considerations, dialysis protein loss, and a case study.
Join Wendy Phillips, a seasoned volunteer and professional leader as she shares her tips and tricks to advancing your dietetics career through leadership. She discusses networking, finding opportunities, and how to advocate for yourself as a dietitian.
Still finding your groove when counseling patients going home on enteral nutrition? Want to see how two experts counsel their patients? Join Carly and Stacy as they act out a patient counseling situation for discharging home with a PEG tube including important conversation topics like feeding schedules, hydration, tube care, and more!
Working in an ICU setting, you may come across patients requiring Continuous Renal Replacement Therapy (CRRT). Join Susy RD, LDN as she shares about when CRRT might be used, nutrition goals for CRRT patients, and how to approach needs requirements.