Current Insights in ICU Nutrition

Nutrition support plays a crucial role in the care of critically ill patients. This review aims to shed light on the latest findings regarding critical care nutrition, with a particular emphasis on the complex relationship between critical illness, the gastrointestinal tract, and nutrition support. The review also examines the available evidence concerning the optimal administration route, type, dosage, and timing of nutrition in this patient population. By exploring these key aspects, we can gain a better understanding of how to effectively provide nutrition support in critical care settings.

While indirect calorimetry is the recommended method for measuring energy expenditure, predictive equations are commonly used in practice. However, these equations have limitations as they often lack accuracy when applied to individual patients. Current evidence supports the early initiation of enteral nutrition (EN) in most patients, with a gradual increase in the daily dose during the first week of critical illness. Patients with severe shock may benefit from delayed EN. Recent trials suggest that parenteral nutrition is comparable to EN in terms of effectiveness and may be considered if adequate EN is not achieved within the first week. Although a higher protein dose is recommended, the optimal timing for its administration remains uncertain. Routine use of immuno-nutrition in critically ill patients is not recommended. Patients receiving artificial nutrition should be closely monitored for metabolic abnormalities. Further well-designed studies with sufficient sample sizes are needed to address many remaining unanswered questions in this field.

Dr. Abouchala joined UAB as an Assistant Professor of Medicine in Pulmonary and Critical Care Medicine in July 2021. He has also currently held the position of Associate Professor of Medicine at the University of North Dakota, School of Medicine & Health Sciences, since October 2019, where he previously held the position of the Medical Director of the Medical & Surgical ICU, and Program Director of the Critical Care Fellowship.  

Before his time at UAB, Dr. Abouchala worked as Assistant Professor of Medicine at the University of Tennessee in Memphis, where he also completed his residency and fellowship training in pulmonary and critical care medicine. Dr. Abouchala completed his initial medical training at Aleppo Medical School in 1983.

The ICU REACH Team