Strategy of Nutritional Support in Septic Patients
Jin Won Huh1
1Department of Pulmonology and Critical Care Medicine, Asan Medical Center, Republic of Korea
Nutrition support is important in critically ill patients because malnutrition is associated with morbidity and mortality. Hypermetabolism and gastrointestinal dysfunction result in a greater risk of malnutrition in patients with sepsis.
Many studies showed the conflicting findings for the effect of energy intake in critically ill patients. Arabi et al. showed that there was no difference in 90-day mortality in a subgroup of 292 patients with sepsis when comparing a permissive underfeeding group and standard feeding group. Although guidelines suggest that critically ill patients with sepsis should receive early initiation of EN in the first 7 days, it can be difficult to reach nutrition targets with enteral feeding alone. In the NUTRIREA-2 study, early EN and early parenteral nutrition did not differ with regards to clinical outcomes including mortality and the risk of ICU-acquired infections in critically ill patients with shock. Recently, many studies have indicated the importance of protein supply in nutrition support, with optimal protein supply potentially improving mortality in critically ill patients. At the International Protein Summit, it was suggested that high doses of protein may be required in ICU settings, to optimize nutrition support and improve mortality rates. Some guidelines recommend a protein intake of 1.2–2 g/kg/day for patients with sepsis. A prospective observational study found that reaching both protein and energy targets was associated with decreased 28-day mortality, but only reaching the energy target was not associated with reduced mortality.
Given the differences in conditions and comorbidities between patients, the response to nutritional intervention is not always uniform. Patients with sepsis who are malnourished or at risk of malnutrition may receive the greatest benefit from an aggressive nutritional support.