Nutrition Therapy and Critical Illness

Practical Guidance for the ICU, Post-ICU, and Long-Term Convalescence Phases

Arthur Raymond Hubert van Zanten; Elisabeth De Waele; Paul Edmund Wischmeyer


Crit Care. 2019;23(368) 

In This Article


The interaction of acute metabolic changes, inflammation, and nutrition in early critical illness is complex. Newer insights suggest that progressive feeding in the early phase for both proteins and calories is essential to prevent overfeeding and high caloric intake during the development of refeeding hypophosphatemia. After this phase of 4–7 days, high-protein intake and sufficient calories are essential to prevent further loss of muscle mass and function.

After ICU discharge, the specific metabolic profile and nutritional needs of ICU survivors remain largely unknown and demand further research. Scarce data reveal poor nutritional practices for patients who left the ICU, are in the ward, and still have a long journey ahead of them.

Following hospital discharge, we must ensure our patients are complying with high-protein targets either by prolonged tube feeding or by enhanced high-protein oral nutrition (supplement) intake. Further, nutritional and metabolic therapies such as anabolic/anticatabolic agents in the recovery need urgent study.

But, to begin winning this war on long-term ICU outcomes and give our patients back the lives they came to us to restore, we must be thoughtful about optimal provision of nutrition and metabolic therapies throughout all phases of illness and ensure our patients are getting the right nutrition, in the right patient, at the right time!