guidelines of nutrition in ICU

1. CARING FOR PATIENTS IN ICU: WHAT ARE THE GUIDELINES?

3. NUTRITION SCREENING
•Essential to identify high risk patients and prioritize early aggressive
nutrition intervention
•Options
–MST
–MUST
– NRS-2002
–NUTRIC or modified NUTRIC score
–Patients are assessed and a nutrition plan is implemented in a timely
manner
Skipper A, et al. J Acad Nutr Diet. 2020;120(4):709-713. Barazzoni R, et al. Clin Nutr. 2020;39(6):1631-1638.
McClave SA, et al. JPEN J Parenter Enteral Nutr. 2016;40(2):159-211.
MST- Malnutrition Screening Tool
MUST- Malnutrition Universal Screening Tool
NRS- Nutrition Risk Screening
NUTRIC- The Nutrition Risk in Critically

4. INDIRECT CALORIMETRY STUDIES
•Yu PJ, et al. JPEN 2020:
–Retrospective study of 7 intubated COVID-19 patients, single measurement each, varying points in illness
(hospital day 8-55)
–Mean MREE = 4044 kcals/day, 235.7% ± 51.7% of predicted using Penn State equation
•Whittle J, et al. Crit Care 2020:
–More complex study design, measuring energy expenditure in 22 COVID-19 patients every 72 hr
•Confirm week 1 ASPEN recommendations: 15-20 kcal/kg
•Week 2: ~ 26 kcal/kg (actual weight for non obese; adjusted weight for obese)
•Week 3: ~ 29 kcal/kg for non obese; 32.5 kcal/kg adjusted weight for obese patients
Important to recognize the variability in energy expenditure – measure energy
expenditure if you can, but at least increase energy delivery after that first
week!
Yu PJ, et al. JPEN J Parenter Enteral Nutr. 2020;44(7):1234-1236. Whittle J, et al. Crit Care. 2020;24(1):581.

6. CLINICAL GUIDELINES: ENERGY

7. CLINICAL GUIDELINES: PROTEIN
ASPEN GUIDELINES ESPEN GUIDELINES
•BMI < 30 kg/m2: 1.2-2 g/kg actual
weight
•Obesity (all classes): 2-2.5 g/kg
IBW
•For BMI < 30 kg/m2: 1.3 g/kg
•For BMI > 30 kg/m2: 1.3 g/kg adjusted
weight for obesity
Martindale R, et al. JPEN J Parenter Enteral Nutr. 2020;44(7):1174-1184. McClave SA, et al. JPEN J Parenter Enteral Nutr.
2016;40(2):159-211.
Barazzoni R, et al. Clin Nutr. 2020;39(6):1631-1638.

35. EARLYENTERALNUTRITION SHOULD IDEALLY BE IN A
LIQUID FORM
Reference: 1.Limketkai BN, et al.Curr Gastroenterol Rep. 2019;21(9):47.
Liquid enteral
nutrition 1
Servesas an exclusive or
partial source ofnutrition
Addresses the nutritional needs of
those individuals who are unable to
consumeadequate calories by mouth
Fulfills the nutritional needs of
patientswho cannotconsumesolid

36. CLOSEDSYSTEMLIQUID ENTERALNUTRITION HAS ADDED
BENEFITS
OS:Open System
Reference: 1.Parrish CR. Practical Gastroenterology. 2015;28-38. 2.Wagner DR, et al.JPEN J Parenter Enteral Nutr. 1994;18(5):453-7.
Provides 84% of required
nutrition vs.74% with OS1
Helps to reduce cross-
contamination by 97.6%2

38. SUMMARY