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Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, Mayer K, Montejo-Gonzalez JC, Pichard C, Preiser JC, Szczeklik W, van Zanten ARH, Bischoff SC. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr 2023; 42:1671-1689. [PMID: 37517372 DOI: 10.1016/j.clnu.2023.07.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
Following the new ESPEN Standard Operating Procedures, the previous 2019 guideline to provide best medical nutritional therapy to critically ill patients has been shortened and partially revised. Following this update, we propose this publication as a practical guideline based on the published scientific guideline, but shortened and illustrated by flow charts. The main goal of this practical guideline is to increase understanding and allow the practitioner to implement the Nutrition in the ICU guidelines. All the items discussed in the previous guidelines are included as well as special conditions.
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Affiliation(s)
- Pierre Singer
- Intensive Care Unit, Herzlia Medical Center and Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, and Intensive Care Unit, Herzlia Medical Center, Israel.
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Mette M Berger
- Faculty of Biology and Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Philip C Calder
- School of Human Development and Health, Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Michael Casaer
- Clinical Department and Laboratory of Intensive Care Medicine, Catholic University Hospitals (UZLeuven) and Catholic University Leuven, Leuven, Belgium
| | - Michael Hiesmayr
- Division Cardiac-, Thoracic-, Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria
| | - Konstantin Mayer
- Department of Pneumonology, Infectious Diseases and Sleep Medicine, St. Vincentius Kliniken gAG, Karlsruhe, Germany
| | | | - Claude Pichard
- Department of Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland
| | - Jean-Charles Preiser
- Medical Direction, Hopital Universitaire de Bruxelles, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College & Anesthesia and Intensive Care Department, 5th Military Hospital, Krakow, Poland
| | - Arthur R H van Zanten
- Department of Intensive Care, Gelderse Vallei Hospital, Ede, The Netherlands & Wageningen University & Research, Wageningen, the Netherlands
| | - Stephan C Bischoff
- Department of Nutritional Medicine/Prevention, University of Hohenheim, Stuttgart, Germany
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Lopez-Delgado JC, Grau-Carmona T, Trujillano-Cabello J, García-Fuentes C, Mor-Marco E, Bordeje-Laguna ML, Portugal-Rodriguez E, Lorencio-Cardenas C, Vera-Artazcoz P, Macaya-Redin L, Martinez-Carmona JF, Mateu-Campos L, Gero-Escapa M, Gastaldo-Simeon R, Vila-García B, Flordelis-Lasierra JL, Montejo-Gonzalez JC, Servia-Goixart L. The Effect of Enteral Immunonutrition in the Intensive Care Unit: Does It Impact on Outcomes? Nutrients 2022; 14:1904. [PMID: 35565870 PMCID: PMC9103218 DOI: 10.3390/nu14091904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The present research aimed to evaluate the effect on outcomes of immunonutrition (IMN) enteral formulas during the intensive care unit (ICU) stay. Methods: A multicenter prospective observational study was performed. Patient characteristics, disease severity, nutritional status, type of nutritional therapy and outcomes, and laboratory parameters were collected in a database. Statistical differences were analyzed according to the administration of IMN or other types of enteral formulas. Results: In total, 406 patients were included in the analysis, of whom 15.02% (61) received IMN. Univariate analysis showed that patients treated with IMN formulas received higher mean caloric and protein intake, and better 28-day survival (85.2% vs. 73.3%; p = 0.014. Unadjusted Hazard Ratio (HR): 0.15; 95% CI (Confidence Interval): 0.06−0.36; p < 0.001). Once adjusted for confounding factors, multivariate analysis showed a lower need for vasopressor support (OR: 0.49; 95% CI: 0.26−0.91; p = 0.023) and continuous renal replacement therapies (OR: 0.13; 95% CI: 0.01−0.65; p = 0.049) in those patients who received IMN formulas, independently of the severity of the disease. IMN use was also associated with higher protein intake during the administration of nutritional therapy (OR: 6.23; 95% CI: 2.59−15.54; p < 0.001), regardless of the type of patient. No differences were found in the laboratory parameters, except for a trend toward lower triglyceride levels (HR: 0.97; 95% CI: 0.95−0.99; p = 0.045). Conclusion: The use of IMN formulas may be associated with better outcomes (i.e., lower need for vasopressors and continuous renal replacement), together with a trend toward higher protein enteral delivery during the ICU stay. These findings may ultimately be related to their modulating effect on the inflammatory response in the critically ill. NCT Registry: 03634943.
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Affiliation(s)
- Juan Carlos Lopez-Delgado
- Intensive Care Department, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Spain
- IDIBELL (Institut d’Investigació Biomèdica Bellvitge, Biomedical Investigation Institute of Bellvitge), Av. de la Gran Via, 199, 08908 L’Hospitalet de Llobregat, Spain
| | - Teodoro Grau-Carmona
- Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain; (T.G.-C.); (C.G.-F.); (J.L.F.-L.); (J.C.M.-G.)
- i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain
| | - Javier Trujillano-Cabello
- Intensive Care Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; (J.T.-C.); (L.S.-G.)
- IRBLLeida (Institut de Recerca Biomèdica de Lleida Fundació Doctor PiFarré, Lleida Biomedical Research Institute’s Doctor PiFarré Foundation), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain
| | - Carlos García-Fuentes
- Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain; (T.G.-C.); (C.G.-F.); (J.L.F.-L.); (J.C.M.-G.)
- i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain
| | - Esther Mor-Marco
- Intensive Care Department, Hospital Universitario Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Spain; (E.M.-M.); (M.L.B.-L.)
| | - Maria Luisa Bordeje-Laguna
- Intensive Care Department, Hospital Universitario Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Spain; (E.M.-M.); (M.L.B.-L.)
| | - Esther Portugal-Rodriguez
- Intensive Care Department, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain;
| | - Carol Lorencio-Cardenas
- Intensive Care Department, Hospital Universitari Josep Trueta, Av. de França, s/n, 17007 Girona, Spain;
| | - Paula Vera-Artazcoz
- Intensive Care Department, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí, 89, 08041 Barcelona, Spain;
| | - Laura Macaya-Redin
- Intensive Care Department, Complejo Hospitalario de Navarra, C/Irunlarrea, E, 31008 Pamplona, Spain;
| | | | - Lidón Mateu-Campos
- Intensive Care Department, Hospital General Universitario de Castellón, Avda. de Benicàssim, 128, 12004 Castelló de la Plana, Spain;
| | - Maria Gero-Escapa
- Intensive Care Department, Hospital Universitario de Burgos, Av. Islas Baleares, 3, 09006 Burgos, Spain;
| | - Rosa Gastaldo-Simeon
- Intensive Care Department, Hospital de Manacor, Carretera Manacor-Alcudia, s/n, 07500 Manacor, Spain;
| | - Belen Vila-García
- Intensive Care Department, Hospital Universitario Infanta Cristina, Av. 9 de Junio, 2, 28981 Parla, Spain;
| | - José Luis Flordelis-Lasierra
- Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain; (T.G.-C.); (C.G.-F.); (J.L.F.-L.); (J.C.M.-G.)
- i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain
| | - Juan Carlos Montejo-Gonzalez
- Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain; (T.G.-C.); (C.G.-F.); (J.L.F.-L.); (J.C.M.-G.)
- i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain
| | - Lluís Servia-Goixart
- Intensive Care Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; (J.T.-C.); (L.S.-G.)
- IRBLLeida (Institut de Recerca Biomèdica de Lleida Fundació Doctor PiFarré, Lleida Biomedical Research Institute’s Doctor PiFarré Foundation), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain
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3
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Servia-Goixart L, Lopez-Delgado JC, Grau-Carmona T, Trujillano-Cabello J, Bordeje-Laguna ML, Mor-Marco E, Portugal-Rodriguez E, Lorencio-Cardenas C, Montejo-Gonzalez JC, Vera-Artazcoz P, Macaya-Redin L, Martinez-Carmona JF, Iglesias-Rodriguez R, Monge-Donaire D, Flordelis-Lasierra JL, Llorente-Ruiz B, Menor-Fernández EM, Martínez de Lagrán I, Yebenes-Reyes JC, Servia-Goixart L, Trujillano-Cabello J, Escobar-Ortiz J, Montserrat-Ortiz N, Zapata-Rojas A, Grau-Carmona T, Bautista-Redondo I, Cruz-Ramos A, Diaz-Castellanos L, Morales-Cifuentes M, Bono MP, Montejo-Gonzalez JC, Temprano-Vazquez S, Arjona-Diaz V, Garcia-Fuentes C, Mudarra-Reche C, Orejana-Martin M, Lopez-Delgado JC, Lores-Obradors A, Anguela-Calvet L, Muñoz-Del Río G, Revelo-Esquibel PA, Alanez-Saavedra H, Serra-Paya P, Luna-Solis SM, Salinas-Canovas A, De Frutos-Seminario F, Rodriguez-Queralto O, Gonzalez-Iglesias C, Zamora-Elson M, Fuente-O'Connor EDL, Arbeloa CS, Bueno-Vidales N, Iglesias-Rodriguez R, Martin-Luengo A, Sanchez-Miralles A, Marmol-Peis E, Ruiz-Miralles M, Gonzalez-Sanz M, Server-Martinez A, Vila-Garcia B, Lorencio-Cardenas C, Macaya-Redin L, Flecha-Viguera R, Aldunate-Calvo S, Flordelis-Lasierra JL, Rio IJD, Mampaso-Recio JR, Rodriguez-Roldan JM, Gastaldo-Simeon R, Gimenez-Castellanos J, Fernandez-Ortega JF, Martinez-Carmona JF, Lopez-Luque E, Ortega-Ordiales A, Crespo-Gomez M, Ramirez-Montero V, Lopez-García E, Navarro-Lacalle A, Martinez-Garcia P, Dominguez-Fernandez MI, Vera-Artazcoz P, Izura-Gomez M, Hernandez-Duran S, Bordeje-Laguna ML, Mor-Marco E, Rovira-Valles Y, Philibert V, Alcazar-Espin MDLN, Higon-Cañigral A, Calvo-Herranz E, Manzano-Moratinos D, Portugal-Rodriguez E, Andaluz-Ojeda D, Parra-Morais L, Citores-Gonzalez R, Garcia-Gonzalez MT, Sanchez-Giron GR, Navas-Moya E, Ferrer-Pereto C, Lluch-Candal C, Ruiz-Izquierdo J, Castor-Bekari S, Leon-Cinto C, Martinez de Lagran I, Yebenes-Reyes JC, Nieto-Martino B, Vaquerizo-Alonso C, Almanza-Lopez S, Perez-Quesada S, Anton-Pascual JL, Marin-Corral J, Sistachs-Baquedano M, Hacer-Puig M, Picornell-Noguera M, Mateu-Campos L, Martinez-Valero C, Ortiz-Suñer A, Llorente-Ruiz B, Martinez-Diaz MC, Muñoz De La Peña MT, Rodriguez-Serrano DA, Fernandez-Salvatierra L, Barcelo-Castello M, Millan-Taratiel P, Tejada-Artigas A, Martinez-Arroyo I, Araujo-Aguilar P, Fuster-Cabre M, Andres-Gines L, Soldado-Olmo S, Menor-Fernandez EM, Lage-Cendon L, Touceda-Bravo A, Sanchez-Ales L, Almorin-Gonzalvez L, Gero-Escapa M, Martinez-Barrio E, Ossa-Echeverri S, Monge-Donaire D. Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality? Clin Nutr ESPEN 2022; 47:325-332. [DOI: 10.1016/j.clnesp.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
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