Monitoring and evaluation of the efficacy of nutrition support in the intensive care unit

Abstract

In the intensive care unit (ICU), nutrition support is a part of patients’ management. As for ventilation and hemodynamics, nutrition and metabolism monitoring is mandatory for improving tolerance and efficacy of nutrition support. Enteral nutrition (EN) is commonly associated with protein-energy deficiency, which is related to poor prognosis. Early detection of deficiency should lead to increase protein and energy delivery, including EN-parenteral nutrition (PN) combination. Overfeeding-related metabolic complications of PN should be screened. Glycaemic monitoring is requested since glycaemic control may result in decreased mortality. In the ICU, macro- and micronutriment intakes, energy expenditure, and matching between protein-energy target and delivery, should be tightly monitored. This monitoring should be computer-based and integrated in patients’ management. An ICU dedicated dietitian may allow to decrease energy deficiency. Since weight, height, serum albumin, and transthyretin could be unsufficient for any definitive diagnosis, assessment of body composition may be useful to allow an accurate assessment of nutrition support efficacy during ICU stay. By limiting protein-energy deficiency and overfeeding and by optimizing glycaemic control, nutrition and metabolism monitoring should improve clinical outcome. Future studies will be helpful to determine the medico-economic impact of nutrition and metabolism monitoring.