SCCM Podcast SCCM Pod-401 Enteral Nutrition in the Critically Ill
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Nov 27, 2019 Jayshil Patel, an Associate Professor of Medicine specializing in critical care nutrition, joins Michael Smith, MD, to delve into managing malnutrition in critically ill patients. They discuss the crucial role of protein supplementation, challenging traditional energy-focused approaches. Patel emphasizes individual assessments for nutritional needs and the impact of early enteral nutrition on recovery. They also explore guidelines for optimizing protein delivery and the complexities of evaluating nutritional status in a hyper-catabolic state.
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Critical Illness Drives Proteolysis
- Critical illness is a hyper-catabolic state that prioritizes glucose production and proteolysis over fat utilization.
- This process creates a caloric debt and predisposes patients to acquired malnutrition with worse outcomes.
Aim For High Protein Targets Early
- Deliver higher protein to critically ill patients, aiming for 1.2–2.0 g/kg/day as per ASPEN/SCCM recommendations.
- Consider even higher protein for select patients with acquired malnutrition or specific needs.
Early Feeding Supports The Gut
- Early enteral nutrition primarily supports gut function, preserving epithelial barrier and immune balance rather than fully reversing catabolism.
- Small trophic or hypocaloric feeds can maintain gut integrity while avoiding intolerance in the early acute phase.