The purpose of this narrative review is to describe the mechanisms for gut dysfunction during critical illness, outline hypotheses of gut-derived inflammation, and identify nutrition and non-nutritional therapies that have direct and indirect effects on preserving both epithelial barrier function and gut microbiota during critical illness.

Clinical and animal model studies have demonstrated that critical illness pathophysiology and interventions breach epithelial barrier function and convert a normally commensal gut microbiome into a pathobiome. As a result, the gut has been postulated to be the "motor" of critical illness and numerous hypotheses have been put forward to explain how it contributes to systemic inflammation and drives multiple organ failure. Strategies to ameliorate gut dysfunction have focused on maintaining gut barrier function and promoting gut microbiota commensalism. The trajectory of critical illness may be closely related to gut epithelial barrier function, the gut microbiome and interventions that may contribute towards a deleterious pathobiome with immune dysregulation.

Oral nutrition is the predominant mode of nutrition delivery on the post-Intensive Care Unit (ICU) ward; yet, it is associated with lower intake than via enteral or parenteral nutrition. There are limited data on barriers that influence oral intake in ICU survivors. Therefore, we conducted a scoping review to map and describe physiological nutrition-impacting symptoms following ICU discharge. Database searches of MEDLINE, Emcare, and CINAHL identified primary research in English that included adult patients eating orally throughout the post-ICU period. Data were extracted on study design, aim, population, post-ICU setting, and the physiological nutrition-impacting symptoms reported, including method of reporting and symptom prevalence. Twenty-nine studies comprising between 11 and 357 participants were included, most of which were prospective and observational in design. Post-ICU settings varied and were inclusive of acute care wards (n = 7, 23%), rehabilitation facilities (n = 5, 16%), and various timepoints following hospital discharge (n = 19, 61%). Key physiological nutrition-impacting symptoms reported were dysphagia (n = 25, 86%) and poor appetite (n = 10, 34%). Other common symptoms included early satiety, fatigue, and nausea. Variations occurred in both the method used to quantify symptoms and the prevalence of each symptom across isolated timepoints. The proportion of patients reporting at least one nutrition-impacting symptom at each time point was 16%-78% on the acute care ward, 29%-95% in rehabilitation facilities, and 10%-71% following hospital discharge. Further studies are required to determine which symptoms ICU survivors experience and their trajectory and impact on oral intake.

Previous meta-analyses on the mode of enteral nutrition in intensive care unit (ICU) have not explored whether the standard practice of continuous enteral feeding is superior to intermittent or bolus feeding among mechanically ventilated patients. Large feed volumes maybe one of the barriers for the use of intermittent feeding. However, intermittent feeding when routinely paired with right lateral tilt positioning may be better tolerated. Aligning feeding-fasting periods with circadian patterns may also be beneficial during critical illness in relation to important patient-centered clinical outcomes.

This systematic review and meta-analysis will summarize the current state of evidence from all randomized controlled trials (RCTs) comparing standard continuous gastric feeding and intermittent gastric feeding (with or without right lateral tilt positioning) among critically ill adult patients receiving mechanical ventilation in ICU.

A systematic search was conducted in MEDLINE, EMBASE and CENTRAL for relevant RCTs published in the English language until September 2024. The primary outcome was all cause hospital mortality, expressed as pooled risk ratio (RR) for the standard continuous feeding relative to intermittent feeding. Key secondary outcomes were ICU length of stay, gut intolerance (vomiting and diarrhoea) and pneumonia.

Sixteen studies were identified for full text review out of a total of 678 records screened. Eight RCTs enrolling a total of 993 patients were included in this meta-analysis. There was a substantial heterogeneity in outcomes selection, definitions, and reporting among these RCTs. Aggregate effect size for the primary outcome was RR 0.97 (95 % confidence interval 0.72-1.32, I2 = 9 %) for standard continuous feeding versus intermittent feeding. There were no between-group differences for any of the other secondary outcomes. Of all the included RCTs, the point estimate for all-cause mortality was least favourable (RR 1.55, 95 % CI 0.82 to 2.93) for the standard continuous feeding in the RCT that compared it against intermittent postural feeding.

Overall, our meta-analysis did not detect any clinically relevant differences in important clinical outcomes between the two groups. Future RCTs should prioritise clinically meaningful, patient-centred outcomes such as mortality or ventilator-free days as primary endpoints.

CRD42024591074.

Patients with severe tetanus exhibit clinical features such as trismus, tetanic spasms, and rigidity, primarily affecting muscle groups including masseter muscles, erector spinae muscles, abdominal muscles, and limb muscles. The main objective of this study is to investigate whether post-pyloric feeding can improve the nutritional level of patients and reduce the incidence of feeding intolerance during the treatment of severe tetanus.

A convenience sampling method was used to select 122 patients with tetanus who met the inclusion criteria from January 2020 to November 2023, and divided into groups that received Nasogastric feeding (NGF, n = 36) and Nasointestinal feeding (NIF, n = 36). Basic information was collected, nutritional biochemical indicators and frequency of intolerance were analyzed.

By day 7 and 14, the NIF group exhibited significantly higher levels of Albumin (ALB), Total Protein (TP), Prealbumin (PA) and Retinol Binding Protein (RBP) compared to the NGF group. At the same time, the incidence of nutritional intolerance in the NIF group was significantly lower compared to the NGF group.

Post-pyloric feeding can improve the nutritional level of patients with severe tetanus and reduce the frequency of feeding intolerance (diarrhea, abdominal distension and vomiting).

Medical nutrition therapy (MNT) is fundamental for ICU patients. This post-hoc subgroup analysis of the prospective observational EuroPN survey aimed to assess MNT in the participating Belgian ICUs.

MNT practices in 9 Belgian ICUs (148 patients) were compared to 77 ICUs (1172 patients) from 11 European countries during the first 15 days for patients staying ≥5 days in ICU - and with the 2019 ESPEN guideline on clinical nutrition in ICU (<70 % of estimated energy expenditure in week 1 and up to 1.3 g/kg/d protein). Additionally, overfeeding was evaluated in the Belgian cohort.

The Belgian cohort had longer median ICU and hospital length of stay, higher emergency room admission rates and delayed MNT initiation compared to overall (EN: day 2.5 [2.0;4.0] vs 2.0 [2.0;4.0] and PN: day 5.0 [3.0,7.0] vs 2.0 [2.0,4.0]). They received more often EN than PN. In week 1 overfeeding was on average present in 30 % (energy) and 15 % (protein) of observation days.

Similar to overall, the Belgian subgroup received a daily average moderate caloric and low protein intake. The gradual intake increase aligned with ESPEN guidelines, though temporary overfeeding occurred in about one third of the patients.

Phosphorus is a vital mineral crucial for various physiological functions. Critically ill trauma patients frequently experience hypophosphatemia during the immediate post-traumatic phase, potentially impacting outcomes. This study aims to investigate the incidence of early hypophosphatemia in critically major trauma patients.

In this prospective observational study, trauma patients admitted to the intensive care unit (ICU) within one day were enrolled. These patients were categorized into Hypo-P groups and Non-hypo groups based on the development of new-onset hypophosphatemia within 72 h after feeding. The primary outcome assessed was the incidence of new-onset hypophosphatemia. The secondary outcomes included ICU and hospital stay, ventilation duration, and mortality.

76.1% of patients developed a new onset of hypophosphatemia within 72 h after feeding. The Hypo-P group had significantly longer ICU stays (8.1 days ± 5.5 vs. 4.4 days ± 3.1; p = 0.0251) and trends towards extended hospital stay, ventilation duration, and higher mortality. Additionally, they demonstrated significantly higher urine fractional excretion of phosphate (FEPO4) on the first ICU day (29.2% ± 14.23 vs. 19.5% ± 8.39; p = 0.0242).

Critically ill trauma patients exhibited a significantly higher incidence of early hypophosphatemia than typical ICU rates, indicating their heightened vulnerability. The significantly high urine FEPO4 underscores the crucial role of renal loss in disrupting phosphate metabolism in this early acute phase after trauma. A significant correlation was observed between hypophosphatemia and longer ICU stays. Monitoring and managing phosphate levels may influence outcomes, warranting further investigation.

Early postpyloric feeding provides effective and safe enteral nutrition for patients with large hemispheric infarction receiving therapeutic hypothermia.

Patients with large hemispheric infarction undergoing therapeutic hypothermia often have gastrointestinal dysfunction and undergo repeated bedside attempts at blind postpyloric feeding tube placement. Confirming tube position via radiography can delay nutrient intake, increase costs, and expose patients to unnecessary radiation.

In this quality improvement study, specialist nurses were trained to use ultrasonography instead of radiography to confirm postpyloric feeding tube position, reducing reliance on ancillary services. Preimplementation and postimplementation data included time from tube placement to first feeding and the frequency of radiography use. Surveys were conducted to assess the health care team's satisfaction with the new process.

Sixty-seven placements (30 before implementation, 37 after implementation) were evaluated. Feeding start times significantly decreased by 34.85% (mean [SD], 741.20 [192.73] minutes before implementation vs 482.86 [166.15] minutes after implementation; P < .001). The addition of ultrasound guidance for postpyloric feeding tube placement significantly decreased the number of abdominal radiographs per patient by 56.0% (mean [SD], 2.5 [0.9] before implementation vs 1.1 [0.4] after implementation; P < .001). Most health care team members indicated that this practice change reduced the time to initiation of enteral nutrition for patients with large hemispheric infarction receiving therapeutic hypothermia.

By improving processes, we reduced feeding start times, minimized radiography use, and enhanced the health care team's satisfaction with postpyloric feeding tube placement for patients receiving therapeutic hypothermia.

Nutrition therapy in the intensive care unit (ICU) is a fundamental aspect of care, but there is minimal guidance for patients with Clostridioides difficile infection (CDI) despite the potentially severe consequences of this infection on the gastrointestinal tract. The aim of this study was to assess nutrition therapy in critically ill patients with CDI compared to those without CDI for differences in nutrition delivery, need for nutrition support, and safety of nutrition therapy.

This was a single-center, retrospective cohort study of patients admitted to the ICU from January 1, 2013, through December 31, 2022. This study compared nutrition therapy in critically ill patients who had CDI compared to a cohort who had diagnoses of other infections. Outcomes included doses of nutrition prescribed, need for nutrition support, and measures of enteral feeding tolerance.

A total of 66 patients were included in this study, 33 in each group. The CDI group received higher median maximum calories (24.3 kcal/kg/day) compared to the control group (21.7 kcal/kg/day) [MD 3.5, 95 % CI 0.05-7.49, p = 0.04] and higher median maximum protein doses (1.1 g/kg/day) to (0.9 g/kg/day) [MD 0.2, 95 % CI 0.04-0.38, p = 0.02]. In the CDI group, significantly more patients required nutrition support (75.8 % and 48.5 %, respectively) [OR 3.32, 95 % CI 1.16-9.84, p = 0.02], but there was no difference in the number of patients who received parenteral nutrition. Measures of enteral feeding safety and tolerance were similar between both groups.

Nutrition therapy for critically ill patients did not appear to be negatively impacted by CDI, and provision of diet or enteral nutrition therapy appeared similarly safe and tolerated compared to those without CDI.

The 2019 Enhanced Recovery After Cardiac Surgery (ERACS) guidelines presented perioperative recommendations to optimize treatment for patients undergoing cardiac surgery (CS). However, the guidelines have not established postoperative nutrition recommendations. Limited studies have analyzed oral intakes after CS, but to our knowledge, none have done so in an ERACS pathway. The main objective of this study was to evaluate the adequacy of postoperative oral intakes, including adherence to oral nutrition supplements (ONSs).

This was an observational prospective study. Postoperative oral intakes were analyzed from postoperative day (POD) 1 to 4, using direct observation of meal plates provided by the hospital. ONSs consumption was evaluated from POD2 to POD4. Adherence to other ERACS recommendations, including nutrition optimization before surgery, was recorded.

Forty-three patients were included in this study. Nutrition optimization before CS was offered to three (7%) patients. Forty-one (95%) patients resumed oral intakes on POD1. Mean oral calorie and protein intakes from POD2 to POD4 were 1088 ± 437 kcal and 0.8 ± 0.3 g/kg, respectively; however, 17 (41%) patients had calorie and protein intakes ≥70% of their estimated requirements. On POD2, ONSs consumption contributed 35% ± 19% and 38% ± 20% of calorie and protein intake, respectively. There was a significant decrease in ONSs consumption starting on POD3.

Within an ERACS pathway and with the contribution of ONSs, 41% of patients achieved sufficient oral intakes within the first 4 days after CS. The optimization of ONSs adherence on postoperative oral intakes should be further studied.

The Modified Nutritional Risk in Critically Ill (mNUTRIC) score has been proposed as a tool to identify hospitalized patients at risk for malnutrition who may benefit from early enteral nutrition (EN) therapy.

Our goal was to determine if mNUTRIC scores could predict, at time of intensive care unit admission, which mechanically ventilated trauma patients were at risk for malnutrition and might benefit from early EN, as indicated by reduced mortality.

We conducted a retrospective chart review of all adult trauma patients requiring mechanical ventilation for at least 48 hours between 01/21/2012 and 12/31/2016, reviewing inpatient medical records, demographic data, disease markers, injury severity, and comorbidities. Bivariate statistics and multivariate regression analyses were used to investigate the correlation between time of EN initiation and mortality rates, as well as the relationship of mNUTRIC scores with EN commencement with early EN initiation being ≤48 hours and malnutrition risk mNUTRIC ≥5.

Among 931 patients reviewed, bivariate analysis showed higher mNUTRIC scores correlated with older, sicker patients and higher mortality. However, multivariate analysis revealed no significant association between higher mNUTRIC scores and increased mortality (OR 1.2, 95% CI 0.7-2.1, p=0.52). Although most patients received EN within 48 hours, there was no association between mNUTRIC score and timing of EN initiation after adjusting for demographic variables and illness severity.

Our findings indicate that while the mNUTRIC score can effectively identify malnutrition risk, it does not meaningfully inform early EN initiation timing nor predict mortality in mechanically ventilated trauma patients.

Patients with critical illness may present with disease-related malnutrition upon intensive care unit (ICU) admission. They are at risk of development and progression of malnutrition over the disease trajectory because of inflammation, dysregulated metabolism, and challenges with feeding.

The Global Leadership Initiative on Malnutrition (GLIM) convened a panel of 36 clinical nutrition experts to develop consensus-based guidance statements addressing the diagnosis of malnutrition during critical illness, using a modified Delphi approach with a requirement of ≥75% agreement.

CONCLUSION: Research using consistent etiologic and phenotypic variables offers great potential to assess the efficacy of nutrition interventions for critically ill patients with malnutrition. Assessment of these variables at during and beyond the ICU stay will clarify the trajectory of malnutrition and enable exploration of impactful treatment modalities at each juncture. GLIM offers a diagnostic approach that can be used to identify malnutrition in critically ill patients.

Respiratory failure is a life-threatening condition that occurs when the lungs are unable to deliver adequate oxygen to the blood or remove carbon dioxide from the body. Patients with respiratory failure often have difficulty maintaining oral nutrition intake because of associated breathlessness and are at increased risk of malnutrition, given both their metabolic response to stress and their dependence on nutrition support. Predictive equations assist clinicians in determining specific energy (caloric) needs for patients with respiratory failure; however, they are inaccurate, complex, and difficult to calculate. Recent technological advances have allowed for commercially available bedside measurement of energy needs using indirect calorimetry. The purpose of this review is to describe how indirect calorimetry (IC) can be used to influence clinical decision-making and nutrition care for patients with respiratory failure who are mechanically ventilated. We provide examples of how IC is utilized in a large tertiary care hospital as well as a small community hospital and strategies for successful adoption of IC.

Enteral nutrition (EN) is a form of nutrition therapy indicated for patients who cannot eat or do not tolerate oral nutrition. However, because of their nutrient-rich composition, EN formulas provide a favorable environment for microbial growth and present a risk for contamination by pathogens, potentially leading to gastrointestinal disorders and delaying patient recovery. This study analyzed the microbiological safety of two EN feeding systems (the open-system [OS] and the ready-to-hang [RTH] system) using liquid and powdered formulas over different infusion periods.

In the laboratory, RTH formulas were administered via infusion pumps without manual handling, whereas OS formulas were prepared manually and administered by gravity. Samples were collected and analyzed for mesophilic aerobic count, an indicator of microbiological quality, at different infusion intervals.

RTH formulas maintained microbial counts below safety limits after 24 and 48 h of infusion. Both liquid and powdered OS formulas remained microbiologically safe for up to 8 h of administration.

This study demonstrated that both the RTH and OS can maintain microbiological safety within the recommended infusion times of 24 and 4 h, respectively, without significant bacterial growth. The safety of these systems is contingent on the implementation of good handling practices, underscoring the need for continuous training of handlers.

Background: Limited information exists regarding the current practice of transitioning from enteral nutrition (EN) to oral nutrition (ON) and the effect of this process on the relationship between energy and protein requirement, provision, and nutritional status of intensive care and post-intensive care patients. Current practices and policies to the transition from EN to ON based on perspectives, experiences and opinions of health professionals and patients, are neither widely understood nor consistently implemented. Aim: The scoping review aims to summarize the current state of research on the transition process from EN to ON in intensive care unit (ICU) patients and post-ICU patients. The aim is to understand the impact of this process on the relationship between energy and protein requirements, and provision, as well as the impact on nutritional status. Additionally, the review aims to gather insights into the perspectives, experiences and opinions of healthcare professionals and patients regarding the transition process and the removal of enteral feeding tubes. Design: The literature search was conducted in PubMed, Cochrane Library and Scopus. Keywords and MeSH terms were applied, with additional papers identified by snowballing. Publications were manually screened based on inclusion and exclusion criteria to determine eligibility for inclusion. Results: A total of six studies were identified on this topic. One study found that, after the feeding tube was removed after ICU discharge, energy intake decreased from 97.3% to 65% and protein intake decreased from 91.5% to 60.6% of target values within one day after removal. Five additional studies revealed that the removal of feeding tubes is often a primary goal for nurses and physicians on the ward, and the decision to remove the tube is not based on an assessment of potential oral energy and protein intake. Reinsertion of a feeding tube is viewed as a setback by nurses and physicians. The process and decision-making of the tube removal seems to be unclear as well as the involvement of patients in the process. No studies were found examining the correlation between nutritional status and the transition process. Conclusions: Energy and protein intake appear to decrease directly after removal of the feeding tube. The decision to remove a feeding tube is often influenced by the personal opinion of healthcare professionals or institutional practices, rather than on the basis of an assessment of oral energy and protein intake. Additional studies are needed to further explore the transition process, the perspectives and experiences of healthcare professionals, and the impact of the process on energy and protein adequacy as well as the nutritional status of ICU and post-ICU patients.

The optimal dose of enteral protein to deliver during critical illness remains uncertain. International clinical practice guidelines recommend protein targets ranging from 1.2 to 2.0 g/kg body weight/day, which is greater than the amount recommended in health. This protocol details the conduct of a systematic review and meta-analysis to evaluate the effect of enteral protein delivered within the international recommended guidelines (1.2-2.0 g/kg/day) compared to less than international recommended guidelines (<1.2 g/kg/day) on mortality and morbidity outcomes.

A systematic review and meta-analysis will be undertaken in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement. A comprehensive literature search of studies indexed in MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials will be conducted. Studies will be included if they are randomised controlled trials (RCTs) enrolling adult critically ill patients comparing predominately enteral protein delivery with one arm receiving 1.2-2.0 g/kg/day protein/kg/day ('greater protein') and another arm receiving <1.2 g protein/kg/day ('lesser protein'). Two independent reviewers will perform title and full text screening for study inclusion, extract data from included studies, and assess study quality using the Cochrane Risk of Bias 2 tool. The primary outcome will be mortality at 90 days. Secondary outcomes will be clinical (infectious complications, and durations of ICU and hospital stays and mechanical ventilation), patient-centred (discharge destination, physical function and quality of life) and muscle (muscle mass, strength) outcomes.

Random-effects meta-analysis will be fitted for all outcomes, and, for the primary outcome, risk ratios will be pooled using a random-effects meta-analysis model and pooled treatment effect presented as risk ratio (95% Confidence Interval).

This systematic review and meta-analysis will compile data to determine whether outcomes are optimised with greater or lesser amounts of enteral protein delivered during critical illness.

CRD42025547923.

To review the rationale for and timing, dose, and monitoring of enteral nutrition and protein delivery in critically ill adults.

Medline searches to identify relevant studies, systematic reviews and meta-analyses, and guidelines informing the phases of critical illness, enteral nutrition and protein doses, and monitoring enteral nutrition.

Preclinical and contemporary clinical literature informing the rationale for and timing, dose, and monitoring of enteral nutrition and protein dose in critically ill adults.

The evidence describing the rationale for and timing, dose, and monitoring of enteral nutrition and protein dose in critically ill adults is summarized.

The early delivery of enteral nutrition remains a cornerstone of therapy for critically ill adults. Historically, critical care nutrition guidelines have recommended achieving full-dose enteral nutrition within the first 72 hours of ICU admission. The rationale for delivering early enteral nutrition depends on the phase of critical illness, and providing a restrictive dose during the acute phase preserves gut integrity, supports the microbiome, and modulates immune dysregulation. Contemporary randomized controlled trials comparing enteral nutrition doses during the acute phase of critical illness have found full-dose enteral nutrition, compared with restrictive dose, and may offset the benefit from enteral feeding, causing iatrogenic stresses to the system leading to worse outcomes. Even though critically ill adults have anabolic resistance and undergo skeletal muscle proteolysis, recent trials have found that high-dose protein, compared with standard, does not improve clinical outcomes and may be harmful in certain subsets of critically ill adults.

Contemporary data support the use of restrictive dose enteral nutrition during the acute phase of critical illness. High-dose protein is not superior to lower and is associated with worse outcomes in critically ill adults with acute kidney injury and those with greater severity of illness.

Overfeeding, currently defined as providing excessive energy and nutrients beyond metabolic requirements, is a common yet often overlooked issue in the intensive care unit (ICU) setting. Understanding the factors contributing to overfeeding and implementing strategies to prevent it is essential for optimizing patient care in the ICU. Several factors contribute to overfeeding in the ICU, including inaccurate estimation of energy requirements, formulaic feeding protocols, and failure to adjust nutritional support based on individual patient needs. Prolonged overfeeding can lead to insulin resistance and hepatic dysfunction, exacerbating glycemic control, increasing the risk of infectious complications, and worsening clinical outcomes. Clinically, overfeeding has been linked to delayed weaning from mechanical ventilation, prolonged ICU stay, and increased mortality rates. Regular review and adjustment of feeding protocols, incorporating advances in enteral and parenteral nutrition strategies, are essential for improving patient outcomes. Clinicians must be proficient in interpreting metabolic data, understanding the principles of energy balance, and implementing appropriate feeding algorithms. Interdisciplinary collaboration among critical care teams, including dieticians, physicians, and nurses, is crucial for ensuring consistent and effective nutritional management. Overfeeding remains a significant concern in the ICU after discharge as well, implying further complications for patient safety and integrity. By understanding the causes, consequences, and strategies for the prevention of overfeeding, healthcare providers can optimize nutrition therapy and mitigate the risk of metabolic complications. Through ongoing education, interdisciplinary collaboration, and evidence-based practice, the ICU community can strive to deliver personalized and precise nutritional support to critically ill patients.

This study evaluated the 30-min diaphragm excursion change rate (ΔDE30-0) as a novel predictor of weaning success compared to existing parameters in patients with severe pneumonia requiring invasive mechanical ventilation.

This retrospective cohort study enrolled patients with severe pneumonia requiring invasive mechanical ventilation (n = 100). The patients were divided into successful (n = 79) and failed (n = 21) extubation groups. Ultrasound measurements of diaphragm excursion (DE) were performed at baseline (DE0) and 30 min (DE30) during a spontaneous breathing trial. The ratio ΔDE30-0 was calculated as the absolute difference between DE30 and DE0 divided by DE0. Additional parameters including rapid shallow breathing index (Rapid Shallow Breathing Index, RSBI) and respiratory rate (RR) were also assessed. The predictive performance of ΔDE30-0 and other parameters was evaluated using receiver operating characteristic (ROC) curves.

The extubation failure group had significantly higher ΔDE30-0 (0.40 ± 0.20 vs. 0.14 ± 0.12, p < 0.0001), RSBI (59.62 ± 21.77 vs. 47.7 ± 13.6, p = 0.0025), and RR (23.62 ± 2.25 vs. 20.34 ± 2.18, p < 0.0001) compared to the success group. ΔDE30-0 demonstrated the highest predictive performance with an area under the ROC curve of 0.924, sensitivity of 86.1%, and specificity of 95.2% at a cut-off value of 0.209.

ΔDE30-0 is a promising predictor of weaning success in severe pneumonia patients requiring invasive mechanical ventilation. It outperformed existing parameters and demonstrated high predictive accuracy.

Incorporating ΔDE30-0 into weaning protocols may improve decision-making, reduce complications, and optimize outcomes for patients requiring invasive mechanical ventilation due to severe pneumonia. This novel parameter can aid clinicians in identifying suitable candidates for extubation, potentially reducing the risk of weaning failure and associated adverse events.

Objectives: Critically ill COVID-19 patients are at high risk of malnutrition; however, no study has directly compared the prognostic accuracy of different nutritional assessment tools. This study aimed to determine the optimal cutoff values for the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score, Nutritional Risk Screening 2002 (NRS 2002), and Malnutrition Universal Screening Tool (MUST) and to evaluate their predictive value for ICU mortality. Method: A retrospective analysis was conducted on patients with laboratory-confirmed COVID-19 admitted to our ICU between 20 March 2020 and 15 June 2021. Clinical and laboratory data, as well as patient outcomes, were retrieved from electronic medical records and patient charts. The mNUTRIC, NRS 2002, and MUST scores were calculated at ICU admission. Results: The study included 397 patients, with 273 survivors and 124 non-survivors. The median age was 65 (55-76) years, and the median BMI was 26.1 (24.0-29.4). Non-survivors had significantly higher median scores in all three nutritional assessment tools compared to survivors (mNUTRIC: 5 vs. 3, NRS 2002: 4 vs. 3, MUST: 2 vs. 2; p < 0.01). At the optimal cutoff values, mNUTRIC ≥ 4 demonstrated the highest prognostic accuracy (sensitivity: 0.77, specificity: 0.74; AUC = 0.75, CI = 0.70-0.81), followed by NRS 2002 ≥ 4 (sensitivity: 0.63, specificity: 0.60; AUC = 0.62, CI = 0.56-0.67) and MUST ≥ 3 (sensitivity: 0.21, specificity: 0.91; AUC = 0.56, CI = 0.50-0.68). Higher scores were associated with increased disease severity, poorer patient performance, prolonged hospital stays, and elevated ICU, 28-day, and overall hospital mortality rates. Among the three assessment tools, only an mNUTRIC score of ≥ 4 was independently associated with ICU mortality (OR = 1.54, CI = 1.21-1.96, p < 0.01). Conclusions: At ICU admission, mNUTRIC ≥ 4, NRS 2002 ≥ 4, and MUST ≥ 3 were identified as the most accurate predictors of mortality in critically ill COVID-19 patients. However, only the mNUTRIC score was an independent predictor of ICU mortality.

Introduction: Critically ill patients in intensive care units (ICUs) are at high risk of malnutrition, which can result in muscle atrophy, polyneuropathy, increased mortality, or prolonged hospitalizations with complications and higher costs during the recovery period. They often develop ICU-acquired weakness, exacerbated by sepsis, immobilization, and drug treatments, leading to rapid muscle mass loss and long-term complications. Studies indicate that adequate protein and calorie intake can decrease mortality and improve prognosis and recovery. However, optimal implementation remains a critical challenge. Objectives: This narrative review aims to summarize recent advances in nutritional strategies for critically ill patients. It highlights the benefits and limitations of current approaches including enteral (EN) and parenteral nutrition (PN) and examines their impact on clinical outcomes and overall mortality. Additionally, the review explores the emerging role of precision nutrition in critical care using technologies such as metabolomics and artificial intelligence (AI) to provide valuable insights into optimizing nutritional care in critically ill patients. Methods: A comprehensive literature search was conducted to identify recent studies, clinical guidelines, and expert consensus papers on nutritional support for ICU patients. The investigation focused on critical aspects such as the optimal timing for intervention, the route of administration, specific protein and energy targets, and technological innovations to support personalized nutrition, ensuring that each patient receives tailored support based on their unique needs. Results: Guidelines recommend initiating EN or PN nutrition within the first 48 h of admission, using indirect calorimetry (IC) to estimate energy needs, and supplementing protein up to 1.2 g/kg/day after stabilization. IC has gained importance in assessing energy needs but is still underused in the ICU. EN is preferred because it maintains intestinal integrity, reduces the risk of infections, and is recommended within the first 48 h of ICU admission. PN is used when EN is infeasible, but it increases the risk of infection. By integrating metabolomics with transcriptomic and genomic data, we can gain a deeper understanding of the effect of nutrition on cellular homeostasis, facilitating personalized treatments and enhancing the recovery of critically ill patients. Conclusions: AI is becoming increasingly important in monitoring and evaluating artificial nutrition, providing a more accurate and efficient alternative to traditional methods. AI can assist in identifying and managing malnutrition and is effective for estimating caloric and nutrient intake. AI minimizes human error, enables continuous monitoring, and integrates various data sources. The nutritional care of critically ill patients requires collaboration among specialists from diverse fields, including physicians, nutritionists, pharmacists, radiologists, IT experts, and policymakers.

To assess the compliance with the Nutrition Therapy Quality Indicator "prescribed versus infused volume".

Secondary data analysis, performed in four adult wards (clinical and surgical) of a Brazilian university hospital. Data were prospectively collected in two sequential periods - between June and November 2017 (cohort 1) and from May 2018 to May 2019 (cohort 2). The difference between the prescribed and infused diet volume was assessed using the Wilcoxon test; and to measure the relationship between the difference and the mean difference of the prescribed and infused volumes, the method suggested by Bland and Altman was applied.

A total of 494 patients were included. It was observed that patients received, on average, less enteral nutrition than prescribed (-601.3±430ml/day), which represented approximately 46% less diet; only 17.7% of patients were able to reach the target for this indicator (infusion of ≥80% of the prescribed volume). Furthermore, no patients received the entire prescribed volume during the established period.

The volume of diet infused was substantially lower than that prescribed, resulting in low compliance of the indicator monitored in the wards.

Nutritional support is crucial for critically ill patients. Recent clinical studies suggest that both overfeeding during the acute phase of critical illness and overly conservative or delayed nutritional therapy can pose significant risks. Given substantial individual variability among critically ill patients, it is challenging to prescribe universally applicable and objective feeding strategies; Instead, we pointed out which nutritional interventions were harmful. We also summarized the reasons for protective nutrition, and elaborated the advantages of protective nutrition from three perspectives: gastrointestinal protection, nutritional protection and metabolic protection. In particular, it is emphasized that overfeeding will lead to metabolic disorders, such as mitochondrial dysfunction, autophagy inhibition, ketogenic inhibition, hyperglycemia, insulin resistance, etc. These detrimental processes can exacerbate one another, contributing to multiple organ dysfunction syndrome and poorer clinical outcomes. We also propose protective nutrition strategies comparable to lung protective ventilation strategies, which may benefit patients. Vigilant monitoring during nutritional implementation is also paramount, enhancing awareness of adverse events for early diagnosis and intervention to mitigate their harm.

Malnutrition and risk for malnutrition in critically ill patients are associated with adverse outcomes. However, the adequacy of nutrient intake and its impact on malnutrition have not been entirely determined in previous studies. Above all, this study investigates the relationship between some nutrient intake and malnutrition levels and 28-day death. The observational study was done on patients over 18 years of age in Rafsanjan Intensive Care Unit (ICU) from April 21 to October 24, 2022. Subjective global assessment (SGA), modified nutrition risk in critically Ill (mNUTRIC) Score, demographic details and intake of some nutrients were assessed. Data was analyzed with SPSS 22 software, and a p-value of 0.05 was a significant level for all analysis.118 patients were studied. Malnutrition and mNUTRIC score are linked to 28-day mortality in logistic regression analysis (OR: 3.63, 95%CI 1.48-8.91, p = 0.004 and OR: 12.69, 95%CI 4.42-36.43, p < 0.001, respectively). There was no significant difference between the intake of some nutrients and malnutrition/ risk for malnutrition. This study reveals no relevance between nutrient intake with malnutrition and risk for malnutrition. Moreover, in malnourished patients, some nutrient intake was unrelated to the 28-day death. It is suggested that future studies be done with a larger sample size.

Background: Malnutrition is a prevalent yet often overlooked issue in lung cancer patients, significantly affecting surgical outcomes. This review examines the impact of nutritional status on lung cancer surgery and explores the role of nutritional assessment and intervention strategies. Methods: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science. Key studies on nutritional status assessment, preoperative nutritional support, and their impact on surgical outcomes were analyzed. Results: Malnutrition in lung cancer patients is associated with increased postoperative complications, prolonged hospital stays, and reduced survival rates. Various assessment tools, including dietary interviews, physical examinations, laboratory tests, and body composition analyses, can help identify malnourished patients. Nutritional support strategies such as high-protein diets, oral supplements, enteral and parenteral nutrition, and perioperative immunomodulation improve clinical outcomes. Conclusions: Implementing standardized nutritional assessment and support protocols is crucial for optimizing surgical outcomes in lung cancer patients. Integrating these strategies into the Enhanced Recovery After Surgery (ERAS) protocol may further enhance recovery and long-term prognosis.

Delivery of enteral nutrition is an essential component of care for patients in the intensive care unit (ICU); however, patients only receive approximately 60% of prescribed enteral nutrition. Volume-based feeding (VBF) has been demonstrated as a safe and effective strategy to catch up for missed delivery of enteral nutrition. The aim of this review was to investigate factors influencing the adherence and implementation of VBF in the adult critical care and high-dependency unit settings to inform future implementation of VBF protocols in the ICU.

Systematic searches of databases (MEDLINE, EMBASE, and Emcare) and grey literature repositories (TROVE, TRIP, CPG Infobase, WorldCat, and Google) were conducted to identify original research studies including adults admitted to the ICU, where VBF or catch-up feeding protocols were in place. Studies reporting on barriers, enablers, and acceptability or adherence to VBF protocols were included.

A total of 28 studies involving 7057 participants were eligible for inclusion, of which 19 were conducted in the USA, seven in Canada, one in the UK, and one in Australia. Factors enabling the implementation of VBF included management support, multidisciplinary team engagement, a project team, multimodal education, and communication strategies. Embedding the protocol into current work systems increased success. Barriers included a culture of deprioritising nutrition, safety concerns, staff turnover, and failure to embed the changes into work systems including the electronic medical record. VBF was considered acceptable to ICU staff; however, adherence to VBF protocols was variable (between 32.1% and 90%).

Successful implementation of a VBF protocol is enabled by strong project leadership, staff education, team engagement, and embedding VBF into current work processes. VBF is acceptable to staff; however, continuous education is recommended to sustain change in practice. Implementation of VBF should be considered as part of an "enhanced" feeding strategy in the ICU setting.

The protocol was developed and registered a priori on Open Science Framework on 8th August 2023 (https://doi.org/10.17605/OSF.IO/8DJKY).

Patients with critical illness may present with disease-related malnutrition upon intensive care unit (ICU) admission. They are at risk of development and progression of malnutrition over the disease trajectory because of inflammation, dysregulated metabolism, and challenges with feeding.

The Global Leadership Initiative on Malnutrition (GLIM) convened a panel of 36 clinical nutrition experts to develop consensus-based guidance statements addressing the diagnosis of malnutrition during critical illness using a modified Delphi approach with a requirement of ≥75% agreement.

(1) To identify pre-existing malnutrition, we suggest evaluation within 48 h of ICU admission when feasible (100% agreement) or within 4 days (94% agreement). (2) To identify the development and progression of malnutrition, we suggest re-evaluation of all patients every 7-10 days (97% agreement). (3) To identify progressive loss of muscle mass, we suggest evaluation of muscle mass as soon as feasible (92% agreement) and again after 7-10 days (89% agreement). (4) To identify the development and progression of malnutrition before and after ICU discharge, we suggest re-evaluating nutrition status before ICU discharge and during clinical visits that follow (100% agreement).

Research using consistent etiologic and phenotypic variables offers great potential to assess the efficacy of nutrition interventions for critically ill patients with malnutrition. Assessment of these variables during and beyond the ICU stay will clarify the trajectory of malnutrition and enable exploration of impactful treatment modalities at each juncture. GLIM offers a diagnostic approach that can be used to identify malnutrition in critically ill patients.

Trauma patients have historically been considered profoundly hypermetabolic. The purpose of this study was to describe energy expenditure using indirect calorimetry and to compare indirect calorimetry to predictive equations in trauma patients.

Indirect calorimetry was performed using a Q-NRG+ by a trained dietitian nutritionist. Results were obtained in mechanically ventilated trauma patients between September 2023 and June 2024. Demographic data, injury characteristics, and outcomes were collected. Results were compared with energy expenditure predicted with 20, 25, and 30 kcal/kg; Penn State 2003b; and Schofield in adolescents on the day of indirect calorimetry using the Wilcoxon test. Subanalysis was completed in adolescents and older adults. Energy expenditure was evaluated over time.

A total of 164 indirect calorimetry results from 117 patients were analyzed. Among participants, median age was 43 (28-62) years, 85% were with blunt mechanism of injury, and and 80% were male. Median energy expenditure was 1869 kcal/day (1618-2265 kcal/day). In the full cohort, 20 kcal/kg underestimated energy needs, whereas other equations overestimated needs. In adolescents, 25 kcal/kg and Schofield were not significantly different than indirect calorimetry (P = 0.15 and 0.64). In older adults, 20 kcal/kg was not significantly different from indirect calorimetry (P = 0.58). A weak association was observed between prescribed and measured energy (r = 0.32, P < 0.001).

Predictive equations recommended in critical care do not accurately reflect energy expenditure in trauma patients. Indirect calorimetry remains the preferred method for determining energy needs and the availability of the bedside dietitian nutritionist to perform these assessments facilitates timely, serial testing.

Better understanding the impact of dietetic services on nutrition practices seems required as it may represent an opportunity for optimization in post-cardiac surgery patients. The present study aims to evaluate and compare nutrition practices and clinical outcomes in post-cardiac surgery intensive care unit (ICU) patients with and without dietetic services.

This is a secondary analysis of a multinational prospective observational study in patients (n = 237) with >72 h of post-cardiac surgical ICU stay with and without dietetic services describing nutrition practices and outcomes up to 12 days after ICU admission.

Dietetic services were available in 61.5% (8 of 13) ICUs (1.0 ± 0.5 full-time equivalents/10 beds). Enteral nutrition was initiated <48 h from ICU admission in 49.6% and 59.1% of patients at sites with vs without dietetic services, respectively. Parenteral nutrition was started within 118.3 ± 56.5 and 131.5 ± 69.2 h at sites with vs without dietetic services, respectively. Energy target (23.7 ± 4.8 vs 24.6 ± 4.8 kcal/kg body weight/day) and actual supply (10.5 ± 6.7 vs 10.3 ± 6.2 kcal/kg body weight/day) did not differ between the groups. Protein targets (1.4 ± 0.4 vs 1.1 ± 1.3 g/kg body weight/day) and actual protein provision (0.6 ± 0.4 vs 0.4 ± 0.3 g/kg body weight/day) were higher in patients at sites with vs without dietetic services.

Improvements in medical nutrition therapy practices in patients after cardiac surgery are needed in ICUs with and without dietetic services. Appropriately staffed dietetic services as essential members of the medical care team may be crucial to transfer knowledge on adequate medical nutrition therapy strategies into practice.

Predictive equations often inaccurately estimate energy needs in critically ill patients. This study evaluated the level of agreement between resting energy expenditure using 12 and 25 kcal/kg as recommended by the 2021 American Society for Parenteral and Enteral Nutrition critical care guidelines for nutrition support and energy expenditure measured by indirect calorimetry in patients in the intensive care unit.

An agreement study was conducted on mechanically ventilated adults who had a documented measured energy expenditure within 10 days of intensive care unit admission. Agreement was assessed using Bland-Altman plots and Wilcoxon signed rank tests. A subgroup analysis was performed for patients with a body mass index of ≥30 kg/m² using actual body weight, adjusted body weight, and ideal body weight. Correlations between measured energy expenditure and patient characteristics were also explored.

Fifty-eight patients were included and were a median age of 64 years, 63.8% male, and a median body mass index of 28.0 kg/m2. The 12 kcal/kg and 25 kcal/kg differed significantly from measured energy expenditure (P < 0.001). Bland-Altman plots showed mean biases of -644.6 kcal/day for 12 kcal/kg and 406.5 kcal/day for 25 kcal/kg. In the body mass index ≥30 kg/m² subgroup (n = 22), 12 kcal/kg underestimated measured energy expenditure across all weights, and 25 kcal/kg was more accurate when using ideal or adjusted body weights.

Predicted energy expenditure using 12 kcal/kg and 25 kcal/kg based on the 2021 American Society for Parenteral and Enteral Nutrition critical care guidelines for nutrition support had poor agreement with measured energy expenditure in mechanically ventilated patients.

Severe pneumonia is a leading cause of mortality and morbidity worldwide. Being a complex condition caused by a variety of microorganisms including bacteria, viruses, and fungi, it requires intensive care. A combination of early initiation of antimicrobial therapy and adjunctive nonantimicrobial interventions improve patient outcomes. This article reviews the most recent data on the epidemiology, microbiology, diagnosis, and management of severe pneumonia.

Moderate-severe hypophosphatemia (M-SHypoP), moderate-severe hypokalemia (M-SHypoK), and moderate-severe hypomagnesemia (M-SHypoM) are prevalent mineral disturbances in critically ill patients, particularly in the ICU setting. Despite their clinical significance, these disturbances have received limited attention in recent medical literature. This study aimed to investigate their prevalence in critically ill adult ICU patients receiving total parenteral nutrition (PN) compared with non-ICU patients receiving total PN.

A historical retrospective cohort analysis was conducted using prospectively collected data from a quaternary hospital over an 8-year period. A total of 736 patients, older than 19 years and receiving PN, were included. Nutritional status (body weight and height) was assessed before starting nutritional support. Serum concentrations of phosphorus, potassium, and magnesium were evaluated within the first 7 days after initiating PN infusion.

Out of 736 patients included in the study, 545 (74 %) were admitted to the ICU. ICU patients had higher rates of surgical procedures (P = 0.009), and mortality (P = 0.001). Laboratory monitoring revealed common phosphorus imbalance in ICU patients, particularly during the first 4 days after PN infusion. ICU participants developed more M-SHypoP when compared to non-ICU (P = 0.002).

Prompt detection and treatment of mineral imbalances in ICU patients are crucial. Critically ill patients admitted to ICUs are at a heightened risk of developing hypophosphatemia compared to those not in the ICU. Thus, there is a potential necessity to introduce a novel PN regimen tailored for hypercatabolic patients within the initial 3 days of PN initiation in the ICU.

Vitamin D is commonly used in clinical practice, while its clinical significance in critically ill patients remains controversial. Therefore, we aimed to perform a systemic review and meta-analysis to investigate the effect of vitamin D on this patient population.

We searched for randomized controlled trials (RCTs) in PubMed, Embase, and the Cochrane Library databases from inception until August 15, 2024. Studies evaluating critically ill adult patients who received vitamin D compared to controls were included. The primary outcome was short-term mortality. We used the Cochrane risk of bias tool and GRADE system to evaluate the study quality and evidence. Secondary outcomes were changes in serum 25-hydroxyvitamin D levels, mechanical ventilation (MV) duration, and length of stay (LOS) in the ICU or hospital. We also conducted meta-regression, subgroup analyses, and trial sequential analysis (TSA) to explore the potential heterogeneity among the included trials.

Nineteen RCTs with 2,754 patients were eligible. Overall, vitamin D significantly increased serum 25-hydroxyvitamin D levels and significantly reduced the short-term mortality (risk ratio [RR] = 0.83; 95%CI, 0.70-0.98; p = 0.03, I 2 = 13%), duration of MV (MD = -2.96 days; 95% CI, -5.39 to -0.52; I 2 = 77%; p = 0.02) and ICU LOS (MD = -2.66 days; 95% CI, -4.04 to -1.29, I 2 = 70%; p = 0.0001) but not hospital LOS (MD = -0.48 days; 95% CI, -2.37 to 1.40; I 2 = 31%; p = 0.61). The meta-regression analysis revealed that the proportion of MV (MV%) accounted for the source of heterogeneity, and the subgroup analyses based on MV% suggested that the MV group was more likely to benefit from vitamin D applications than the partly MV group in all the predefined outcomes (all p values<0.05). TSA for short-term mortality suggested that more data is required to confirm our main conclusion.

Vitamin D supplementation increased serum 25-hydroxyvitamin D levels and significantly benefited critically ill patients, especially those with MV.

https://inplasy.com/inplasy-2022-10-0074/, INPLASY2022100074.

nitrogen balance (NB) is the difference between nitrogen ingested and excreted, however its value as a prognostic marker in critically ill patients has yet to be determined. This study aimed to evaluate the association between NB, urinary parameters, and adverse outcomes among ICU patients.

NB, urinary urea (UUE) and creatinine (UCE) excretion were recorded in the first week of ICU. The primary outcome was ICU mortality, and secondary outcomes were time on mechanical ventilation (MV), ICU and hospital length of stay and hospital mortality.

a total of 127 patients were included (58 ± 16 years, 87.4 % clinical admissions). Negative NB was observed in 77.2 % patients in the first and 47.2 % patients in the second measurement, with a protein intake of 40 (25-58) vs 86 (64-107) g/day. The ICU and hospital mortality rates were 22.0 % and 30.7 %. There was no identified cut-off point for sensibility and specificity in the ROC curves for NB and urinary parameters regarding ICU and hospital mortality.

NB, UUE, or UCE were not associated with ICU or hospital mortality in our study. Further research is needed to evaluate the practical value of NB as a prognostic marker in ICU patients.

Biodegradable temporising matrix (BTM) is a dermal substitute developed to reconstruct full thickness burns, yet the subsequent metabolic effects are unknown. This pilot study aimed to 1) measure variation in energy expenditure using indirect calorimetry (IC) in response to BTM application across the continuum of acute burns management and 2) assess accuracy of predictive energy equations commonly used in Australia in adult patients with severe burns.

Energy expenditure was measured (MEE) using IC during distinct time-periods: 'acute surgery'; 'BTM integration'; following 'skin grafting'; and 'acute recovery' and compared to predictive equations (Toronto, Schofield plus injury factor (IF), and the Ratio method from a minimum of 25 kcal/kg/day to a maximum of 40 kcal/kg/day). Agreement was assessed using Lin's concordance correlation coefficient (CCC) and Bland-Altman methods.

Eighteen patients were included (median [Interquartile range] 44 [29-70] years; 39 % [25-56 %] total body surface area burns). MEE reported as estimated marginal means (95 % confidence intervals) for each time-period were: 'acute surgery' 2048 (1847, 2248) kcal; 'BTM integration' 2244 (2071, 2416) kcal; 'skin grafting' 2297 (2123, 2471) kcal; 'acute recovery' 2102 (1918, 2287) kcal, equating to 25 %, 37 %, 41 % and 29 % above predicted basal metabolic rate (Schofield, no injury factor), respectively (all p < 0.001). During 'acute surgery' all equations (Schofield x IF, Minimum and Maximum Ratio method), overestimated energy requirements by 24-42 % (all p < 0.001), except Toronto (-12 %, p = 0.071). Similarly, all equations overestimated energy requirements by 11-27 % throughout 'BTM integration' (all p ≤ 0.01), except Toronto (-5 %, p = 0.12). Following 'skin grafting' Schofield and Maximum Ratio equations overpredicted, while Toronto underpredicted requirements (+16 %, +21 % and -11 %, respectively, p ≤ 0.001). The Maximum Ratio overestimated and Toronto underestimated requirements during 'acute recovery' (+19 %, p = 0.04 and -9 %, p = 0.014, respectively). Average CCC (all time periods) was highest for Toronto at 0.77, with Bland-Altman plots also showing highest accuracy and reliability.

A substantial hypermetabolic response was not observed following BTM application. While the Toronto equation most closely predicted energy requirements, considerable variability was observed, highlighting the value of IC to guide nutrition support in severe burns where nutritional needs change over time. A larger multicentre study is required to substantiate the effect of BTM application on energy expenditure.

This single-center retrospective observational study investigated the association between changes in body composition during hospitalization and outcomes in patients with severe coronavirus disease (COVID-19) pneumonia. Body composition was assessed using chest computed tomography (CT) within 3 days of intensive care unit admission and follow-up CT within 14 days. The study population comprised 89 adult patients, among whom 57 survived. The median APACHE II score on admission was 16. Initial CT scans showed that the iliopsoas muscle volume, sum of the pectoralis major and minor muscle areas, and erector spinae muscle (ESM) area were significantly larger in survivors than in non-survivors (p = 0.019, 0.011, and 0.001, respectively). Subcutaneous fat tissue (SAT) volume was higher in survivors (p = 0.003), and the rate of change in the SAT volume was lower in survivors (p = 0.043). Multivariate logistic regression analysis revealed that a high APACHE II score (OR: 0.834, 95% CI: 0.741-0.938, p = 0.002) and small ESM area (OR: 1.001, 95% CI: 1.000-1.002, p = 0.031) were independent predictors of mortality. In conclusion, the loss of supporting respiratory muscles, particularly ESM, may play a critical role beyond general acute sarcopenia, and the preserved SAT in non-survivors may reflect abnormal glucose metabolism due to severe inflammation.

Sepsis remains the major cause of mortality among critically ill patients worldwide, indicating the importance of better understanding of its influencing factors for fast recognition and management. Although greater concerns have been raised about the "obesity paradox" and sepsis related mortality, the evidence regarding on overweight or obese septic patients is still controversial. To provide more clinical evidence for the exploration of body mass index (BMI) on sepsis prognostic prediction, we assessed the association of BMI with 28-day mortality of septic patients in intensive care unit (ICU).

This was a retrospective observational study with patient data extracted from the eICU Collaborative Research Database. We employed a logistic regression to assess the effect of admission BMI levels on sepsis related mortality risk. Furthermore, the two-piecewise linear model was used to identify BMI mortality thresholds, and BMI-outcome associations were evaluated by interaction tests and subgroup analyses.

Our cohort included a total of 17,454 patients, of whom 1555 (8.91 %) died within 28 days after being admitted to the ICU. The connection between BMI and 28-day mortality in the ICU displayed a U-shaped curve. The threshold effect analysis results in two inflection points of BMI were 23.62 kg/m2 and 45.53 kg/m2. When the BMI was <23.62 kg/m2, the mortality rate decreased by 7 % (95 %CI 0.91, 0.96, P<0.0001) for every 1 increment in the BMI. When the BMI was ≥45.53 kg/m2, the mortality rate increased by 8 % (95 %CI 1.01,1.15, P = 0.0322) for every 1 increment in the BMI. Subgroup analysis showed that neither age nor sex covariates affected the stability of these results (all P for interaction≥0.05).

In septic ICU patients, the correlation between BMI and 28-day mortality exhibited a U-shaped pattern, indicating that both low and extremely high BMIs were linked to a heightened risk of mortality within 28 days.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of perioperative ERAS protocols compared to traditional perioperative care for women undergoing surgery due to non-malignant gynaecological conditions and to review the availability and key findings of health economic evaluations of ERAS, summarising their principal conclusions.

Prokinetics are used to treat gastrointestinal (GI) dysmotility in critically ill dogs but there have been no published studies characterizing their use. The objective of this multi-institutional retrospective cohort study was to describe the use of the prokinetics erythromycin and metoclopramide in dogs hospitalized in two institutions. We hypothesized that there would be change over time and differences between institutions in the use of erythromycin and metoclopramide.

Dogs for inclusion were identified by fee code searches for injectable erythromycin and metoclopramide in the electronic medical record systems of The Animal Hospital at Murdoch University and Western Australian Veterinary Emergency and Specialty Hospital for the years 2018 and 2023. 75 cases from each hospital in each year were selected for inclusion from the search results using a formal randomization procedure to yield a total case number of 300. Data collected for each dog included signalment, diagnosis, reason(s) for starting prokinetics, the injectable prokinetic(s) used, frequency, and doses. Chi square or Fisher's exact tests were used as appropriate to compare the proportions of dogs receiving metoclopramide alone, erythromycin alone, or both prokinetics in 2018 and 2023, the proportions of dogs receiving metoclopramide or erythromycin as sole prokinetics between the two institutions, and the proportions of dogs receiving a single prokinetic versus dual prokinetics between the two institutions.

Primary GI diseases accounted for the majority of the diagnoses. The most common reasons for starting a prokinetic were vomiting, an imaging diagnosis of ileus, prophylaxis following abdominal surgery, and regurgitation. Metoclopramide was administered as a sole prokinetic in the majority of dogs, fewer cases received erythromycin alone, or both prokinetics. Use of metoclopramide alone decreased from 2018 to 2023, with more dogs receiving erythromycin alone or both prokinetics in 2023. There were also significant differences in prokinetic use between institutions.

Prospective studies to investigate the effectiveness and safety of metoclopramide and erythromycin as prokinetics in dogs are warranted.

A placement within critical care provides valuable experience for Intensive Care Medicine trainees and those training in other specialties. However, the environment is different from what you have previously experienced on the wards and can initially seem daunting. This guide aims to help demystify some of the critical care jargon so that you can feel more prepared for your time in the intensive care unit (ICU).

The 4-meter gait speed (4MGS), a functional performance test, is increasingly used to predict health outcomes. This study investigated 4MGS, nutritional status, frailty, and daily living activities in tertiary care pulmonary diseases ward patients.

Patients were assessed for nutritional status, activities of daily living, and frailty using the Mini Nutritional Assessment (MNA) Test, Barthel Questionnaire, and FRAIL scale. Those with 4MGS < 1 m/sec were classified as having slow gait speed.

80 patients (F/M: 21/59, mean age 58 ± 19) were included. Diagnoses included pneumonia, chronic obstructive pulmonary disease, pleural effusion, and interstitial lung disease. Patients had a 4MGS of 0,74 ± 0,24 m/sn, MNA score of 14.0 [IQR 25-75:11.0-19.8] points, Barthel index of 95 [IQR 25-75:70-100] points, FRAIL scale of 3 [IQR 25-75:1.0-4.0], and a hand-grip strength of 18.8 [IQR 25-75:15.7-25.9] kg. Slow gait speed patients had lower MNA, FRAIL scores, and handgrip strength. Multivariable regression analysis showed that slower gait speed was associated with lower serum protein level (B = 0.013, SE = 0.005, 95% CI: 0.004 to 0.022, p = 0.004), lower hand grip strength (B = -0.002, SE = 0.001, 95% CI: -0.003 to -0.00006, p = 0.041) and malnutrition risk (B = 0.024, SE = 0.007, 95% CI: 0.011 to 0.038, p < 0.001).

4MGS correlates with comorbidities, frailty, grip strength, and nutritional status in hospitalized pulmonary patients. Slow gait patients are more malnourished despite similar age, sex, BMI, and comorbidities.