Leah Gramlich, a leading gastroenterologist and nutrition specialist from Alberta, shares her extensive expertise on enteral nutrition in the ICU. The conversation delves into the critical impact of nutrition on patient recovery, emphasizing personalized dietary strategies. Gramlich highlights the ongoing debate between bolus and continuous feeding methods. She also discusses the evolving perspectives on gastric residual measurements and the importance of managing complications like glycemic issues. Listeners gain insight into the future of nutritional practices in critical care.
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Impact of Malnutrition in Hospitals
Disease-related malnutrition affects up to 50% of hospitalized patients with serious negative outcomes.
Malnutrition is linked to prolonged stays, higher mortality, and more complications in hospitals.
volunteer_activism ADVICE
When to Start Enteral Nutrition
Use enteral nutrition when oral intake is under 75% for more than five days with a functional gut.
Aim to avoid energy deficits greater than 10,000 calories over 10 days to reduce mortality in critically ill patients.
insights INSIGHT
Full Feeding Early May Harm ICU Patients
Early full feeding in acute critical illness is not beneficial and may cause harm.
Evidence shows feeding at full calorie and protein targets in the first phase might prolong ICU stay and increase complications.
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The Overstory is a sweeping and impassioned work of environmental fiction that follows the lives of nine individuals whose paths are intertwined by their connections to trees. The novel is structured in four parts – 'Roots', 'Trunk', 'Crown', and 'Seeds' – mirroring the parts of a tree. It delves into themes of ecology, climate change, and the interconnectedness of trees and humans, using a blend of science, history, and magical realism. The book advocates for the protection of trees and the natural world, posing critical questions about humanity's relationship with the environment and the long-term consequences of human actions[2][4][5].
In this episode of, Dr. Sergio Zanotti explores the vital role of enteral nutrition in the ICU—a foundational element in the prevention and treatment of disease-related malnutrition among critically ill patients. He is joined by Dr. Leah Gramlich, a distinguished gastroenterologist and physician nutrition specialist from the Royal Alexandra Hospital in Alberta, Canada. Dr. Gramlich is a Professor of Medicine at the University of Alberta and the founding president of the Canadian Nutrition Society. She has also served on the Board of Directors for the American Society for Parenteral and Enteral Nutrition and chaired the Canadian Malnutrition Task Force, bringing deep expertise to this essential topic.
Additional resources:
Enteral Nutrition in Hospitalized Adults. Lead Gramlich, Peggi Guenter. New Engl J Med 2025: https://pubmed.ncbi.nlm.nih.gov/40239069/
Individualized nutritional support in medical inpatients at nutritional risk: a randomized clinical trial. The EFFORT Clinical Trial. Lancet 2019: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32776-4/abstract
Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). Lancet Respir Med 2023: https://pubmed.ncbi.nlm.nih.gov/36958363/
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: https://pubmed.ncbi.nlm.nih.gov/36708732/
Books mentioned in this episode:
The Overstory: A Novel. By Richard Powers: https://bit.ly/43Drra1
Critical Matters 