Restricted proof recommend that evaluation of muscle mass, oblique calorimetry, and cautious monitoring of urea stage might assist information diet remedy in older sufferers within the intensive care unit (ICU), in keeping with a Singapore examine. Different suggestions for common ICU sufferers could also be used for these with sound scientific discretion.
“There have been solely 5 randomized managed trials (RCTs) for 2 subjects: route or timing of diet remedy and pharmaconutrition,” the researchers mentioned. “In distinction, amongst common critically sick sufferers … there have been already 207 RCTs with 23,091 sufferers throughout 34 subjects.” [J Parenter Enteral Nutr 2010;34:697-706]
The databases of Medline and Embase had been searched via 9 February 2022 for research on critically sick sufferers aged ≥60 years assessing any space of diet remedy. The researchers didn’t apply any examine design or language restrictions.
Thirty-two research together with 5 RCTs met the eligibility standards. Six subjects had been recognized, as follows: (1) diet screening and assessments, (2) muscle mass evaluation, (3) route or timing of diet remedy, (4) willpower of vitality and protein necessities, (5) vitality and protein consumption, and (6) pharmaconutrition. [Ann Acad Med Singap 2022;51:629-636]
Comparable findings had been famous for subjects 1, 3, and 6 amongst common grownup ICU sufferers. Skeletal muscle mass at ICU admission was markedly decrease in older than youthful sufferers. Low muscularity at ICU admission elevated the danger of hostile outcomes in older critically sick sufferers.
“Skeletal muscle is probably the most considerable tissue and the primary reservoir of amino acids for important organs through the burdened state,” the researchers mentioned. [Am J Clin Nutr 1992;56:19-28;
Calcif Tissue Int 2015;96:183-195]
“The direct measurements of muscle mass utilizing imaging procedures akin to computed tomography and ultrasound at ICU admission might extra exactly mirror sufferers’ dietary standing,” they added. [Clin Nutr 2022;41:1425-1433]
Power, protein necessities
Primarily based on weight-based equations, predicted vitality necessities considerably strayed from oblique calorimetry measurements in older sufferers in comparison with their youthful counterparts. As well as, older ICU sufferers wanted increased protein consumption (>1.5 g/kg/day) to attain nitrogen steadiness, however they run the danger of growing azotaemia at related protein consumption.
“General, the optimum vitality and protein dose for older critically sick sufferers are but to be decided,” the researchers mentioned.
“Physiologic information recommend that older sufferers require increased protein consumption than youthful sufferers; nonetheless, warning must be exercised with increased protein as older sufferers are at a better threat of azotaemia than youthful sufferers at related protein consumption,” they added. [J Parenter Enteral Nutr 2015;39:282-290; J Parenter Enteral Nutr 2022;46:75-82]
To information diet intervention, the American Society for Parenteral and Enteral Vitamin 2016 tips really useful utilizing Vitamin Threat Screening 2002 (NRS-2002) and an ICU-specific diet rating (modified diet threat in critically sick [mNUTRIC]). Of be aware, solely the latter was developed and validated amongst ICU sufferers. [Crit care 2011;15:R268;
Clin Nutr 2016;35:158-162]
“Much like common grownup critically sick sufferers, present proof means that mNUTRIC and Subjective World Evaluation could also be the perfect out there instruments to help prognostication of scientific outcomes in older critically sick sufferers,” the researchers mentioned. “Excessive-quality RCTs are wanted to find out whether or not these instruments can establish sufferers who might profit from increased diet supply.”