Dietitian Blog, MNT Guidelines, Nutrition Support | Apr 19 2017

What’s new in nutrition support therapy?

parenteral nutrition shortage in wake of hurricane maria

New guidelines were released in January 2016

Appropriate Nutrition Therapy has been shown to have positive outcomes on the critically ill patient.

American Society for Parenteral and Enteral Nutrition (ASPEN) and The Society for Critical Care Medicine (SCCM) released new guidelines in January 2016, for provision and assessment of nutrition support therapy in critically ill adult patients.

The new guidelines address: assessment, initiation, dosing, and monitoring of EN as well as type of EN formula, adjunctive therapy, when to use PN and how to monitor the efficacy of PN.

2016 guidelines recommend that both nutrition status of the patient and disease severity be taken into account when assessing the ICU patient.

New guidelines recommend the use of standard polymeric formulas for patients in the ICU, it is no longer recommended to use Omega-3 specialty formulas for those patients with respiratory issues.

It is no longer recommended to measure Gastric Residual Volumes (GRVs). Guidelines suggest that GRVs no longer be used as part of routine monitoring of ICU patients with EN. Evidence has shown that eliminating the measuring of GRVs improves delivery without jeopardizing patient safety.

It is further recommended that if GRVs continue to be checked EN should only be held with >500ml residual and other symptoms of intolerance.

Guidelines further suggest that the key macronutrient for ICU patients is protein. Diet/EN of ICU patients should be regularly reassessed to ensure adequate intake of protein.

In summary the key recommendations include:

  • Early assessment of ICU patients with calculations for energy and protein
  • Initiation of EN within 24-48hrs of admission to the ICU
  • Elimination of routine GRV monitoring for intolerance and holding of EN
  • Initiation of early PN when EN not feasible in previously poorly nourished patients or when patient is high risk and unable to tolerate sufficient EN.

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About Janet Feinstein

Janet Feinstien, RD, LD, CNSC, is Dietitians On Demand’s permanent travel registered dietitian. She has more than 36 years of clinical, wellness and food service experience.

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