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Changing paradigms in metabolic support and nutrition therapy during critical illness

van Zanten, Arthur R.H.

Current Opinion in Critical Care: August 2018 - Volume 24 - Issue 4 - p 223–227
doi: 10.1097/MCC.0000000000000519
METABOLIC SUPPORT: Edited by Arthur R.H. van Zanten

Purpose of review To summarize the most recent advances in acute metabolic care and critical care nutrition.

Recent findings Recent research has demonstrated unknown consequences of high protein and amino acid administration in the early phase of ICU stay associated with dysregulated glucagon release leading to hepatic amino acid breakdown and suggested adverse effects on autophagy and long-term outcome. Progress has been made to measure body composition in the ICU. Refeeding hypophosphatemia and refeeding syndrome are common during critical illness, phosphate monitoring is essential after the start of nutrition therapy, and caloric restriction is recommendable in these patients.

In recent studies, enteral nutrition is no longer superior to parenteral nutrition and signals of harm using the enteral route in shock have been suggested. However, during extracorporeal life support, enteral nutrition seems well tolerated. Intermittent or bolus enteral feeding seems an exciting concept concerning its potential anabolic effects. Studies on vitamin C, thiamine, and corticosteroid combinations suggest potential to improve outcome.

Summary These new findings will probably change the practice of metabolic and nutrition therapy in critical illness and challenge paradigms advocated for long.

Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands

Correspondence to Arthur R.H. van Zanten, MD, PhD, Internist-intensivist, Medical Advisor Executive Team, Department of Intensive Care, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands. Tel: +31 318 43 41 15; fax: +31 318 43 41 16; e-mail:

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