Because the NRS-2002 does not specialize in ICU patients, almost all ICU patients are considered at “risk” just because admission to the ICU (acute physiology and chronic health evaluation II score > 10) adds 3 points. This guideline defines low nutritional risk as Nutritional Risk Screening (NRS) 2002 ≤ 3 or Nutrition Risk in Critically ill (NUTRIC) scores ≤ 5. Thus, ensuring optimal calorie administration is important in nutritional therapy.Īs per the guidelines of the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (ASPEN), nutritional risk should be determined for all patients admitted to the intensive care unit (ICU). It is associated with hypoglycemia, hypothermia, infectious complications, impaired immunity, impaired healing, loss of lean and fat body mass, and impaired muscle function. Contrastingly, underfeeding is defined as energy administration below 70% of the defined target. Because of the complex interplay among autophagy, immune responses, and inflammation, overfeeding should be avoided in critically ill patients. Recently, impairment of autophagy caused by overfeeding is receiving a lot of attention. It is associated with hyperglycemia, hyperlipidemia, hypercapnia, infectious complications, impaired immunity, liver steatosis, and increased fat mass. Overfeeding is defined as energy administration of 110% above the defined target. Therefore, they concluded that both overfeeding and underfeeding might be harmful for critically ill patients. revealed that increasing the calorie administration/resting energy expenditure (REE) to 70% was associated with decreased mortality, while an increase above 70% was associated with increased mortality, especially an increase to > 100%. In fact, a retrospective study conducted by Zusman et al. As with any antibiotic treatment, both over and under administration of calories are harmful to critically ill patients. Why is it necessary to think about optimal calorie administration before discussing the appropriate calorie dosage? For example, for treating an infectious disease, if vancomycin is not given at an appropriate dosage, there could be a risk of treatment failure due to under administration and a risk of kidney injury due to over administration. In this article, the concepts of optimal calorie administration in critically ill patients were reviewed. Thus, it is important to accurately determine the energy requirement and to make the required changes in the administered calorie dose to go from a strategy of “defense” to that of “offense” in a timely manner. Contrastingly, cumulative negative energy balance can also be harmful to critically ill patients. Until the patient’s condition improves, less than 18 kcal/kg/day might be an optimal calorie target. If patients have low nutritional risks, these estimated values should not be adopted in the acute phase. Several studies and guidelines have shown that the strategies for nutritional therapy depend on the nutritional risk of patients. Therefore, the use of formulas, such as the Harris-Benedict equation, or the simple predictive value of 25 kcal/kg/day is reasonable. Although indirect calorimetry is the gold standard for assessing energy expenditure, many intensivists are unable to use this technique. How to estimate calorie consumption and how to determine an optimal calorie dose are clinical questions of great importance. Nutritional therapy is one of the important treatments in critically ill patients.
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