On how to feed critically ill children in intensive care: a slowly shifting paradigm

Clinical Nutrition, Год журнала: 2025, Номер 46, С. 169 - 180

Опубликована: Фев. 6, 2025

Critically ill children requiring treatment in a pediatric intensive care unit (PICU) suffer from anorexia and/or feeding intolerance. The resulting macronutrient deficit associates with poor outcome. Until recently, this association formed the basis for initiating enteral or parenteral early to improve multicenter "Early-versus-Late-Parenteral-Nutrition-in-the-Pediatric-Intensive-Care-Unit" randomized controlled trial (PEPaNIC-RCT) addressed whether is causal. It showed that supplementation of insufficient/contraindicated nutrition nutrition, as compared accepting throughout first week PICU, did not On contrary, it caused more infections and prolonged organ support PICU stay, adversely affected neurodevelopmental outcomes 2 4 years later. Harm was present all subgroups appeared explained by dose, specifically amino-acid lipid glucose doses. These findings corroborated results large-scale adult RCTs. Mechanisms harm enhanced comprised suppressed cellular repair pathways like autophagy ketogenesis, illness-induced alterations thyroid hormone metabolism, iatrogenic hyperglycemia, increased urea cycle activity through anabolic resistance, induction epigenetic modifications mediate longer-term developmental impairments. came unexpected many intensivists. Hence, paradigm has only slowly begun shift toward restrictive administration acute phase critical illness. Benefits fasting responses have become clear, provided micronutrients are given prevent deficiencies refeeding syndrome. insights open perspectives studies investigating novel nutritional strategies activate fasting-induced while avoiding starvation.

Язык: Английский

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Advancements in nutritional support for critically ill patients

Current Opinion in Critical Care, Год журнала: 2025, Номер unknown

Опубликована: Янв. 30, 2025

Purpose of review To summarize the clinical evidence on nutritional support for critically ill patients, (patho)physiological mechanisms involved, and areas future research. Recent findings Large randomized controlled trials have shown that early nutrition induces dose-dependent harm in regardless feeding route, high-dose amino acids are harmful. Harm has been attributed to feeding-induced suppression cellular repair pathways including autophagy ketogenesis, aggravation hyperglycemia insulin needs, increased urea cycle activity. Additionally, acute critical illness was be a state anabolic resistance. The absence benefit enhanced short- long-term outcomes observed all studied subgroups. Summary While should avoided optimal initiation time individual patient, as well ideal composition dosing over remain unclear. Future studies elucidate how fasting-induced can activated while avoiding prolonged starvation, high need could prevented. Potential strategies include intermittent fasting, ketogenic diets, ketone supplements, alternative glucose-lowering agents, whether or not combination with exercise.

Язык: Английский

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Nutrition therapy for critically ill patients - five key problems

Clinical Nutrition, Год журнала: 2025, Номер 46, С. 45 - 51

Опубликована: Янв. 6, 2025

A pragmatic trial and its secondary analyses have demonstrated that nutritional care not only reduces complications but also significantly improves survival in medical patients at risk of malnutrition. In contrast, for critically ill comparable evidence is scarce. Consequently, many propositions refining the research agenda study design field critical nutrition already been made. The aim this paper to elucidate further problems care. Critical appraisal literature from past 70 years. We identified five key problems: 1. immunologic background catabolism 2. energy goal during acute phase 3. quantification endogenous substrate production 4. incorporation clinical biological data into design, 5. cardiopulmonary exercise testing recovery phase. solution these should supplement made by other authors essential improving after

Язык: Английский

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Nutrition in the critically ill in resource-limited settings/low- and middle-income countries

Current Opinion in Clinical Nutrition & Metabolic Care, Год журнала: 2025, Номер unknown

Опубликована: Янв. 27, 2025

To share current concepts and provide an overview of the contextual issues nutrition practices in critically ill patients resource-limited settings (RLSs)/low- middle-income countries (LMICs). Most world's population reside these which also carries greatest burden critical illness. There is a paucity evidence on practice RLSs international guidelines are largely based derived from high-income (HICs). While some recommendations adaptable to RLSs, many not feasible or directly transferable. Despite challenges that may prevail, pragmatic solutions can address difficulties enhance improve patient outcomes. This review provides contemporary synopsis covering relevance optimal nutrition, gives insights into relevant evaluates recent scientific available literature pertinent addresses guidelines, discusses options solutions, deals with important complications arise, offers suggestions future considerations settings.

Язык: Английский

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The U-Shaped Curve of Energy Supply in the First 72 Hours of Critical Illness May Apply Only to Patients with Normal Body Mass Index: A Post-Hoc Analysis of a Prospective Observational Multicenter Study

Опубликована: Янв. 1, 2025

Язык: Английский

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The U-shaped Curve of Energy Supply in the First 72 Hours of Critical Illness May Apply Only to Patients with Normal Body Mass Index: A Post-hoc Analysis of a Prospective Observational Multicenter Study

Research Square (Research Square), Год журнала: 2025, Номер unknown

Опубликована: Фев. 14, 2025

Objective Nutritional support is crucial for critically ill patients. Body mass index (BMI) represents nutritional reserves to some extent, but it unclear whether the U-shaped relationship between caloric delivery during acute phase of critical illness and prognosis applies patients across all BMI categories. Methods This secondary analysis a multicenter prospective observational study, which included who were admitted intensive care unit (ICU) at least 3 days. The divided into two subgroups based on BMI: normal overweight (BMI > 25 kg/m²). We used univariate multivariate Cox regression analyses investigate calorie within first 72 hours ICU admission 28-day mortality, explore non-linear exists two. Results A total 361 in final analysis, including 272 subgroup 89 subgroup. In regression, there was significant (P = 0.003) association 0.002) daily delivered calories mortality. Increasing from 0 18 kcal/kg/day associated with decreasing mortality (hazard ratio (HR) 0.892, 95% CI 0.816–0.975), while increasing (HR 1.116, 1.016–1.227)); subgroup, higher also observed increase 1.124, 1.043–1.211, P 0.003), this disappeared (P 0.466). After adjustment, above results still hold up. Conclusions only those < kg/m², no such curve kg/m². Further research needed validate conclusion.

Язык: Английский

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Interruptions in nutritional therapy in children with chronic diseases during the acute phase of critical illness and their effect on the administered volume

Frontiers in Nutrition, Год журнала: 2025, Номер 12

Опубликована: Апрель 30, 2025

Introduction Undernutrition is a common concern among critically ill children and adolescents in the hospital setting. Inadequate delivery of nutrition therapy (NT) can significantly contribute to prevalence undernutrition pediatric intensive care units (PICUs). Objective To assess impact interruptions on volume NT delivered with basal chronic conditions, as well calories proteins provided, during acute phase PICU. Methods A cohort patients conditions was analyzed evaluate administration enteral or parenteral nutrition. The focus not effectively underlying causes incomplete NT. Results total 120 were included, majority whom undernourished (47.5%) by body mass index-for-age (BMI/A). significant proportion prescribed (EN) (PN) administered first third days evaluation. most prevalent reasons for procedures delays complications arising treatment Conclusion Interruptions are frequent children; greater day both EN PN after initiation; mild gastrointestinal main administration.

Язык: Английский

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The urea-to-creatinine ratio as an emerging biomarker in critical care: a scoping review and meta-analysis

Critical Care, Год журнала: 2025, Номер 29(1)

Опубликована: Май 2, 2025

Язык: Английский

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Enteral Nutrition Versus a Combination of Enteral and Parenteral Nutrition in Critically Ill Adult Patients in the Intensive Care Unit: An Overview of Systematic Reviews and Meta-Analysis

Journal of Clinical Medicine, Год журнала: 2025, Номер 14(3), С. 991 - 991

Опубликована: Фев. 4, 2025

Background/Objectives: Uncertainty persists about the best methods and timing for providing medical nutrition therapy (MNT) in acute phase of critical illness. We conducted an overview systematic reviews to examine appraise findings current performed updated meta-analysis incorporating newly published randomized controlled trials (RCTs) investigate whether enteral (EN) is superior combination EN parenteral (PN) patients admitted intensive care unit (ICU). Methods: systematically searched three databases retrieve RCTs. Two independent reviewers screening, data extraction, quality assessment processes. The random effects model was utilized synthesize regarding primary secondary outcomes. Results: There no difference between two interventions efficacy safety endpoints, apart from bloodstream infections, which were found be increased group that received EN+PN (RR = 1.27, 95%CI 1.03 1.56, PI 0.91 1.77, I2 0%). Conclusions: According present meta-analyses, there observed benefit on mortality, length ICU stay or hospitalization, duration mechanical ventilation critically ill receiving a PN comparison those sole ICU. Furthermore, rates respiratory infections as well appearance adverse events, such vomiting diarrhea. On other hand, increase infection who compared alone. Due limited implications results clinical practice, further research needed.

Язык: Английский

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Treatment Response Variations to a Single Large Bolus of Enteral Cholecalciferol in Vitamin D Deficient Critically Ill Children: Metabolomic Insights for Precision Nutrition

The Journal of Steroid Biochemistry and Molecular Biology, Год журнала: 2025, Номер unknown, С. 106720 - 106720

Опубликована: Март 1, 2025

Vitamin D deficiency (VDD) is prevalent globally and in pediatric intensive care units, where it represents a modifiable risk factor that may impact patient recovery during hospitalization. Herein, we performed retrospective analysis of serum samples from phase-II randomized placebo-controlled trial involving single large bolus 10,000 IU/kg vitamin D3 ingested by critically ill children with VDD (25-OH-D < 50 nmol/L). Targeted untargeted methods were used to comprehensively measure 6 metabolites, 239 lipids, 68 polar 4 electrolytes using multi-step data workflow for compound authentication. Complementary statistical classified circulating metabolites/lipids associated repletion following high-dose intake (n=20) versus placebo (n=11) comprising standard maintenance dose (< 1000 IU/day). There was striking increase median concentrations 25-OH-D3 (4.7-fold), 3-epi-25-OH-D3 (24-fold) their C3-epimer ratio (6.7-fold) treated patients on day 3, whereas peaked 1 (128-fold) unlike placebo. Treatment response differences attributed bioavailability C3-epimerase activity without evidence hypercalcemia. For the first time, report detection 3-epi-D3 strongly correlated uptake (r = 0.898). Metabolomic studies revealed sufficiency (serum 25-OH-D >75 nmol/L) coincided lower levels 3-methylhistidine, cystine, S-methylcysteine, uric acid, two lysophosphatidylcholines 7 days after treatment. Rapid correction indicators oxidative stress, inflammation, muscle protein turn-over contribute clinical benefits high-risk children.

Язык: Английский

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