The intensive care medicine research agenda in nutrition and metabolism

Intensive Care Medicine, Apr 2017

Purpose The objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years. Methods Recent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism. Then, members of the panel rated each one of the topics using a grading system (0–4). Potential studies were ranked on the basis of average score. Results Recent randomized controlled trials (RCTs) have challenged several concepts, including the notion that energy expenditure must be met universally in all critically ill patients during the acute phase of critical illness, the routine monitoring of gastric residual volume, and the value of immune-modulating nutrition. The optimal protein dose combined with standardized active and passive mobilization during the acute phase and post-acute phase of critical illness were the top ranked studies for the next 10 years. Nutritional assessment, nutritional strategies in critically obese patients, and the effects of continuous versus intermittent enteral nutrition were also among the highest-ranking studies. Conclusions Priorities for clinical research in the field of nutritional management of critically ill patients were suggested, with the prospect that different nutritional interventions targeted to the appropriate patient population will be examined for their effect on facilitating recovery and improving survival in adequately powered and properly designed studies, probably in conjunction with physical activity.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs00134-017-4711-6.pdf

The intensive care medicine research agenda in nutrition and metabolism

The intensive care medicine research agenda in?nutrition and?metabolism Yaseen M. Arabi 0 Michael P. Casaer Marianne Chapman Daren K. Heyland Carole Ichai Paul E. Marik Robert G. Martindale Stephen A. McClave Jean?Charles Preiser Jean Reignier Todd W. Rice Greet Van den Berghe Arthur R. H. van Zanten Peter J. M. Weijs 0 Intensive Care Department, MC 1425, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU? HS), King Abdullah International Medical Research Center (KAIMRC) , P.O. Box 22490, Riyadh 11426 , Kingdom of Saudi Arabia Full author information is available at the end of the article Purpose: The objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years. Methods: Recent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism. Then, members of the panel rated each one of the topics using a grading system (0-4). Potential studies were ranked on the basis of average score. Results: Recent randomized controlled trials (RCTs) have challenged several concepts, including the notion that energy expenditure must be met universally in all critically ill patients during the acute phase of critical illness, the routine monitoring of gastric residual volume, and the value of immune? modulating nutrition. The optimal protein dose combined with standardized active and passive mobilization during the acute phase and post? acute phase of critical illness were the top ranked studies for the next 10 years. Nutritional assessment, nutritional strategies in critically obese patients, and the effects of continuous versus intermittent enteral nutrition were also among the highestranking studies. Conclusions: Priorities for clinical research in the field of nutritional management of critically ill patients were suggested, with the prospect that different nutritional interventions targeted to the appropriate patient population will be examined for their effect on facilitating recovery and improving survival in adequately powered and properly designed studies, probably in conjunction with physical activity. Nutrition; Metabolism; Critical care; Intensive care; Protein; Calorie - Patient Admitted to the ICU ?Assess for nutritional risk? ?Calculate energy and protein requirement? ?Take steps to improve tolerance to gastric feeding? ?Implement enteral feeding protocol? ?Do not use gastric residual volumes as part of routine care? ?Start PN when EN is not feasible or sufficient in high-risk patients? 6. Immune?modulating nutrition 7. Glucose control Pre-morbid condition Acute illness Recovery phase Post-recovery phase Underlying nutritional risk/ underlying functional status Inflammation Insulin resistance Catabolism/ anabolism Energy expenditure Rehabilitation Autophagy Nutritional therapy in the ICU ? Energy and protein amount ? Macronutrients ? Micronutrients ? Antioxidants ? Route of nutrition Average score 1. Preiser JC , van Zanten AR , Berger MM et al ( 2015 ) Metabolic and nutritional support of critically ill patients: consensus and controversies . Crit Care 19 : 35 2. Dhaliwal R , Madden SM , Cahill N et al ( 2010 ) Guidelines, guidelines, guidelines: what are we to do with all of these North American guidelines? JPEN J Parenter Enter Nutr 34 : 625 - 643 3. Fraipont V , Preiser JC ( 2013 ) Energy estimation and measurement in critically ill patients . JPEN J Parenter Enter Nutr 37 : 705 - 713 4. Oshima T , Berger MM , De Waele E et al ( 2016 ) Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group . Clin Nutr . doi:10.1016/j.clnu. 2016 .06.010 5. Taylor BE , McClave SA , Martindale RG et al ( 2016 ) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Crit Care Med 44 ( 2 ): 390 - 438 6. Rice TW , Mogan S , Hays MA , Bernard GR , Jensen GL , Wheeler AP ( 2011 ) Randomized trial of initial trophic versus full? energy enteral nutrition in mechanically ventilated patients with acute respiratory failure . Crit Care Med 39 : 967 - 974 7. National Heart , Lung, and Blood Institute Acute Respiratory Distress Sydrome (ARDS) Clinical Trials Network, Rice TW et al (2012) Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial . JAMAc 307 : 795 - 803 8. Arabi YM , Aldawood AS , Haddad SH et al ( 2015 ) Permissive underfeeding or standard enteral feeding in critically ill adults . N Engl J Med 372 : 2398 - 2408 9. Al?Dorzi HM , Albarrak A , Ferwana M , Murad MH , Arabi YM ( 2016 ) Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta?analysis . Crit Care 20 : 358 10. Marik PE , Hooper MH ( 2016 ) Normocaloric versus hypocaloric feeding on the outcomes of ICU patients: a systematic review and meta?analysis . Intensive Care Med 42 : 316 - 323 11. Casaer MP , Mesotten D , Hermans G et al ( 2011 ) Early versus late parenteral nutrition in critically ill adults . N Engl J Med 365 : 506 - 517 12. Fivez T , Kerklaan D , Mesotten D et al ( 2016 ) Early versus late parenteral nutrition in critically ill children . N Engl J Med 374 : 1111 - 1122 13. Doig GS , Simpson F , Sweetman EA et al ( 2013 ) Early parenteral nutrition in critically ill patients with short?term relative contraindications to early enteral nutrition: a randomized controlled trial . JAMA 309 : 2130 - 2138 14. Heidegger CP , Berger MM , Graf S et al ( 2013 ) Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial . Lancet 381 : 385 - 393 15. Hermans G , Casaer MP , Clerckx B et al ( 2013 ) Effect of tolerating macronutrient deficit on the development of intensive? care unit acquired weakness: a subanalysis of the EPaNIC trial . Lancet Respir Med 1 : 621 - 629 16. Harvey SE , Parrott F , Harrison DA et al ( 2014 ) Trial of the route of early nutritional support in critically ill adults . N Engl J Med 371 : 1673 - 1684 17. Elke G , van Zanten AR , Lemieux M et al ( 2016 ) Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and metaanalysis of randomized controlled trials . Crit Care 20 : 117 18. Heyland DK , Dhaliwal R , Jiang X , Day AG ( 2011 ) Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool . Crit Care 15 : R268 19. Rahman A , Hasan RM , Agarwala R , Martin C , Day AG , Heyland DK ( 2015 ) Identifying critically?ill patients who will benefit most from nutritional therapy: further validation of the ?modified NUTRIC? nutritional risk assessment tool . Clin Nutr 35 : 158 - 162 20. Arabi YM , Aldawood AS , Al?Dorzi HM , et al ( 2017 ) Permissive underfeeding or standard enteral feeding in high and low nutritional risk critically ill adults: post?hoc analysis of the permit trial . Am J Respir Crit Care Med 195 : 652 - 662 21. Hiesmayr M , Frantal S , Schindler K et al ( 2015 ) The Patient? And NutritionDerived Outcome Risk Assessment Score (PANDORA): development of a simple predictive risk score for 30? day in?hospital mortality based on demographics, clinical observation, and nutrition . PLoS One 10 : e0127316 22. Kondrup J , Rasmussen HH , Hamberg O , Stanga Z , Ad Hoc ESPEN Working Group ( 2003 ) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials . Clin Nutr 22 : 321 - 336 23. Doig GS , Simpson F , Heighes PT et al ( 2015 ) Restricted versus continued standard caloric intake during the management of refeeding syndrome in critically ill adults: a randomised, parallel? group, multicentre, singleblind controlled trial . Lancet Respir Med 3 : 943 - 952 24. Casaer MP , Wilmer A , Hermans G , Wouters PJ , Mesotten D , Van den Berghe G ( 2013 ) Role of disease and macronutrient dose in the randomized controlled EPaNIC trial: a post hoc analysis . Am J Respir Crit Care Med 187 : 247 - 255 25. Reignier J , Mercier E , Le Gouge A et al ( 2013 ) Effect of not monitoring residual gastric volume on risk of ventilator?associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial . JAMA 309 : 249 - 256 26. Montejo JC , Minambres E , Bordeje L et al ( 2010 ) Gastric residual volume during enteral nutrition in ICU patients: the REGANE study . Intensive Care Med 36 : 1386 - 1393 27. Chapman MJ , Besanko LK , Burgstad CM et al ( 2011 ) Gastric emptying of a liquid nutrient meal in the critically ill: relationship between scintigraphic and carbon breath test measurement . Gut 60 : 1336 - 1343 28. Kieft H , Roos AN , van Drunen JD , Bindels AJ , Bindels JG , Hofman Z ( 2005 ) Clinical outcome of immunonutrition in a heterogeneous intensive care population . Intensive Care Med 31 : 524 - 532 29. Heyland D , Muscedere J , Wischmeyer PE et al ( 2013 ) A randomized trial of glutamine and antioxidants in critically ill patients . N Engl J Med 368 : 1489 - 1497 30. Rice TW , Wheeler AP , Thompson BT et al ( 2011 ) Enteral omega?3 fatty acid, gamma?linolenic acid, and antioxidant supplementation in acute lung injury . JAMA 306 : 1574 - 1581 31. van Zanten AR , Sztark F , Kaisers UX et al ( 2014 ) High?protein enteral nutrition enriched with immune?modulating nutrients vs standard high?protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial . JAMA 312 : 514 - 524 32. van Zanten AR , Dhaliwal R , Garrel D , Heyland DK ( 2015 ) Enteral glutamine supplementation in critically ill patients: a systematic review and metaanalysis . Crit Care 19 : 294 33. Luiking YC , Poeze M , Deutz NE ( 2015 ) Arginine infusion in patients with septic shock increases nitric oxide production without haemodynamic instability . Clin Sci (Lond) 128 : 57 - 67 34. van den Berghe G , Wouters P , Weekers F et al ( 2001 ) Intensive insulin therapy in critically ill patients . N Engl J Med 345 : 1359 - 1367 35. Van den Berghe G , Wilmer A , Hermans G et al ( 2006 ) Intensive insulin therapy in the medical ICU . N Engl J Med 354 : 449 - 461 36. Marik PE , Preiser JC ( 2010 ) Toward understanding tight glycemic control in the ICU: a systematic review and metaanalysis . Chest 137 : 544 - 551 37. NICE?SUGAR Study Investigators, Finfer S , Chittock DR et al ( 2009 ) Intensive versus conventional glucose control in critically ill patients . N Engl J Med 360 : 1283 - 1297 38. Van den Berghe G ( 2012 ) Intensive insulin therapy in the ICU-reconciling the evidence . Nat Rev Endocrinol 8 : 374 - 378 39. Haugen HA , Chan LN , Li F ( 2007 ) Indirect calorimetry: a practical guide for clinicians . Nutr Clin Pract 22 : 377 - 388 40. Singer P , Berger MM , Van den Berghe G et al ( 2009 ) ESPEN guidelines on parenteral nutrition: intensive care . Clin Nutr 28 : 387 - 400 41. Casaer MP , Ziegler TR ( 2015 ) Nutritional support in critical illness and recovery . Lancet Diabetes Endocrinol 3 : 734 - 745 42. Marik PE ( 2015 ) Feeding critically ill patients the right 'whey': thinking outside of the box . A personal view. Ann Intensive Care 5:51 43. West DW , Burd NA , Coffey VG et al ( 2011 ) Rapid aminoacidemia enhances myofibrillar protein synthesis and anabolic intramuscular signaling responses after resistance exercise . Am J Clin Nutr 94 : 795 - 803 44. Gazzaneo MC , Suryawan A , Orellana RA et al ( 2011 ) Intermittent bolus feeding has a greater stimulatory effect on protein synthesis in skeletal muscle than continuous feeding in neonatal pigs . J Nutr 141 : 2152 - 2158 45. Liebau F , Sundstrom M , van Loon LJ , Wernerman J , Rooyackers O ( 2015 ) Short?term amino acid infusion improves protein balance in critically ill patients . Crit Care 19 : 106 46. Chowdhury AH , Murray K , Hoad CL et al ( 2016 ) Effects of bolus and continuous nasogastric feeding on gastric emptying, small bowel water content, superior mesenteric artery blood flow, and plasma hormone concentrations in healthy adults: a randomized crossover study . Ann Surg 263 : 450 - 457 47. Doig GS , Simpson F , Bellomo R et al ( 2015 ) Intravenous amino acid therapy for kidney function in critically ill patients: a randomized controlled trial . Intensive Care Med 41 : 1197 - 1208 48. Ferrie S , Allman?Farinelli M , Daley M , Smith K ( 2015 ) Protein requirements in the critically ill: a randomized controlled trial using parenteral nutrition . JPEN J Parenter Enter Nutr 40 : 795 - 805 49. Casaer MP , Van den Berghe G ( 2016 ) Comment on ?Protein requirements in the critically ill: a randomized controlled trial using parenteral nutrition? . JPEN J Parenter Enter Nutr 40 : 763 50. Rugeles S , Villarraga?Angulo LG , Ariza? Gutierrez A , Chaverra?Kornerup S , Lasalvia P , Rosselli D ( 2016 ) High?protein hypocaloric vs normocaloric enteral nutrition in critically ill patients: a randomized clinical trial . J Crit Care 35 : 110 - 114 51. Nicolo M , Heyland DK , Chittams J , Sammarco T , Compher C ( 2016 ) Clinical outcomes related to protein delivery in a critically ill population: a multicenter, multinational observation study . JPEN J Parenter Enter Nutr 40 : 45 - 51 52. Weijs PJ , Looijaard WG , Beishuizen A , Girbes AR , Oudemans? van Straaten HM ( 2014 ) Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non?septic mechanically ventilated critically ill patients . Crit Care 18 : 701 53. Rugeles SJ , Rueda JD , Diaz CE , Rosselli D ( 2013 ) Hyperproteic hypocaloric enteral nutrition in the critically ill patient: a randomized controlled clinical trial . Indian J Crit Care Med 17 : 343 - 349 54. Verreijen AM , Verlaan S , Engberink MF , Swinkels S , de Vogel? van den Bosch J , Weijs PJ ( 2015 ) A high whey protein?, leucine ?, and vitamin D? enriched supplement preserves muscle mass during intentional weight loss in obese older adults: a double?blind randomized controlled trial . Am J Clin Nutr 101 : 279 - 286 55. Stroud M ( 2007 ) Protein and the critically ill; do we know what to give? Proc Nutr Soc 66 : 378 - 383 56. Herridge MS , Tansey CM , Matte A et al ( 2011 ) Functional disability 5 years after acute respiratory distress syndrome . N Engl J Med 364 : 1293 - 1304 57. Wollersheim T , Woehlecke J , Krebs M et al ( 2014 ) Dynamics of myosin degradation in intensive care unit?acquired weakness during severe critical illness . Intensive Care Med 40 : 528 - 538 58. Paris M , Mourtzakis M ( 2016 ) Assessment of skeletal muscle mass in critically ill patients: considerations for the utility of computed tomography imaging and ultrasonography . Curr Opin Clin Nutr Metab Care 19 : 125 - 130 59. Thibault R , Makhlouf AM , Mulliez A et al ( 2016 ) Fat?free mass at admission predicts 28? day mortality in intensive care unit patients: the international prospective observational study Phase Angle Project . Intensive Care Med 42 : 1445 - 1453 60. Hermans G , Van Mechelen H , Clerckx B et al ( 2014 ) Acute outcomes and 1? year mortality of intensive care unit?acquired weakness. A cohort study and propensity?matched analysis . Am J Respir Crit Care Med 190 : 410 - 420 61. Kim HK , Suzuki T , Saito K et al ( 2012 ) Effects of exercise and amino acid supplementation on body composition and physical function in community? dwelling elderly Japanese sarcopenic women: a randomized controlled trial . J Am Geriatr Soc 60 : 16 - 23 62. Heyland DK , Stapleton RD , Mourtzakis M et al ( 2016 ) Combining nutrition and exercise to optimize survival and recovery from critical illness: conceptual and methodological issues . Clin Nutr 35 : 1196 - 1206 63. Hiesmayr M , Schindler K , Pernicka E et al ( 2009 ) Decreased food intake is a risk factor for mortality in hospitalised patients: the NutritionDay survey 2006 . Clin Nutr 28 : 484 - 491 64. Deane AM , Dhaliwal R , Day AG , Ridley EJ , Davies AR , Heyland DK ( 2013 ) Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta?analysis . Crit Care 17 : R125 65. Summers MJ , Chapple LA , McClave SA , Deane AM ( 2016 ) Event?rate and delta inflation when evaluating mortality as a primary outcome from randomized controlled trials of nutritional interventions during critical illness: a systematic review . Am J Clin Nutr 103 : 1083 - 1090


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs00134-017-4711-6.pdf

The intensive care medicine research agenda in nutrition and metabolism, Intensive Care Medicine, 2017, DOI: 10.1007/s00134-017-4711-6