Best timing for energy provision during critical illness

Excerpt

Malnutrition is a persistent problem in hospitals and intensive care units (ICUs) worldwide. Critically ill patients quickly develop malnutrition or aggravate a preexisting malnutrition because of the inflammatory response, metabolic stress and bed rest, which all cause catabolism [1, 2]. The persistence of this problem despite existing guidelines, is partly explained by the absence of immediately visible consequences of acute malnutrition: Deleterious consequences are not easily measurable and become obvious only after 7-14 days, i.e., frequently after discharge from the ICU. Nevertheless, after a week already, new infections may be attributable to incipient malnutrition [3, 4]. In contrast, the biological consequences of insufficient oxygen delivery are immediate, requiring the ICU team's rapid attention. This longer time constant between event and consequence is one of the important reasons why nutritional therapy is so frequently forgotten early on, resulting in progression of energy deficits, in turn associated with impaired outcome. …