Practical Application of the Revised Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: A Case Study Approach

Abstract

Background: Nutrition therapy is an essential component of the care plan for critically ill and injured patients. There is consensus that critically ill patients are at risk for malnutrition, and the associated consequences of increased infectious morbidity, multiorgan dysfunction, prolonged hospitalization, and disproportionate mortality can be minimized with specialized enteral and/or parenteral nutrition therapy.

Methods: In this article, we describe 2 case studies that are intended to introduce the nutrition support clinician to key updates in the recently released Guidelines for 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 (A.S.P.E.N.).

Results: The case studies demonstrate a pragmatic approach to nutrition therapy in the intensive care unit (ICU) and are intended to elicit dialogue for timely, appropriate nutrition care at policy meetings, professional conferences, and ICU daily rounds.

Conclusions: While explicitly stated in the formal document, it is worth repeating that the guidelines are directed toward generalized patient populations, but as with any therapeutic intervention in the ICU, nutrition therapy should be tailored to the individual patient. In addition, protocols and procedures should reflect the local institutional culture and meet with approval of critical care clinicians.

Keywords: critical care; critical illness; enteral nutrition; intensive care units; nutritional support; parenteral nutrition; practice guidelines.