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.

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 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.

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.

To investigate the clinical effects of ultrasound-guided precise nasojejunal catheterization in critically ill patients receiving enteral nutrition.

A total of 120 patients were randomly divided into control and experimental groups in a 1:1 ratio. The control group underwent blind transnasal jejunal catheterization, and the experimental group underwent ultrasound-guided transnasal jejunal catheterization. Indices related to catheterization, complications of catheterization, and nutritional status before and after catheterization were used as observation indices.

The average catheterization time of the experimental group was shorter (21.28 ± 8.96 min), the success rate of one-time catheterization was significantly greater than that in the control group (93.3% vs. 80.0%), and the probability of catheter displacement/detachment was significantly lower in the experimental group than in the control group (p < 0.05). Prealbumin level, total serum protein level, and absolute number of lymphocytes were significantly greater than those in the control group and before catheterization (p < 0.05).

In enteral nutrition intervention for critical patients, accurate ultrasound-guided nasojejunal tube placement has the advantages of short operation time, high success rate, safety, and good nutritional support and is expected to be an ideal method for successful nasojejunal tube placement.

Enteral nutrition (EN) has become the standard of care for nutritional support among critically ill patients. However, little is known about whether continuous delivery (CEN) or intermittent delivery (IEN) is preferable or the consequences of either strategy. This is particularly true for diarrhea, which is understudied but consistently shown to be associated with increased morbidity among critically ill patients. This is a multicenter, retrospective cohort study including critically ill patients greater than 18 years of age, admitted to the Intensive Care Unit in Hamilton, Canada, and prescribed EN for greater than 48 hours. Patients will be divided into IEN and CEN groups based on the nutritional strategy they received during their stay. The primary outcome will be the proportion of patients in each group with diarrhea during their ICU stay, diarrhea will be defined according to WHO criteria. Multivariate logistic regression will be performed to identify the role of covariates in the risk of developing diarrhea. Secondary outcomes will include caloric intake, incidence of ICU-acquired infections, including Clostridioides difficile, length of stay, and mortality. This study protocol has been approved by the Hamilton Integrated Research Ethics Board (#16453). The study findings will be disseminated at academic conferences and published in peer-reviewed journals.

Polytrauma patients in intensive care units (ICUs) face significant risks of morbidity and mortality, with nutrition playing a crucial role in mitigating energy deficits and complications such as multi-organ failure (MOF). This study aimed to evaluate adherence to enteral nutrition (EN) guidelines in ventilated polytrauma patients and explored correlations between EN timing and clinical outcomes.

A four-year retrospective (2019-2022) analysis of ventilated polytrauma patients (abbreviated injury scale > 2 in ≥ 2 body regions) admitted to a level 1 trauma centre. Collected data included demographics, injury characteristics and EN patterns. Early EN was defined as started withing 24 h. Statistical analysis assessed associations between EN, injury severity, and outcomes such as ICU length of stay (LOS), mortality, and MOF.

Of 182 patients (median age 41, male 77%, median ISS 34), 41 did not receive EN and were excluded. Of the remaining 141, 64% received early EN, with a median time to EN of 17.8 h. Early EN was associated with reduced ICU LOS (p = 0.016). Delaying EN initiation correlated with higher injury severity (p = 0.008). Each one-hour delay to EN increased MOF odds by 1.47% (OR: 1.0147, p = 0.07). EN interruptions (> 6 h) occurred 354 times.

Investigations into current EN standards in polytrauma patients demonstrated an average of 2.5 interruptions in EN exceeding 6 h per patient, with 40% not fed within 24 h. Combined with inconsistent dietician input, this offers room for improvement as early EN is associated with better outcomes, with a reduced ICU LOS established through this study.

This meta-analysis aimed to evaluate the factors influencing enteral nutrition feeding intolerance in critically ill patients.

PubMed, Embase, Scopus, Medline, Web of Science, CNKI, VIP, WanFang and CBM databases were searched. A sensitivity analysis was carried out to explore the influence of individual studies on the pooled results of the included studies using a fixed-effects model or a random-effects model. The pooled results were expressed as the odds ratios (ORs) and 95% confidence intervals (Cls). Finally, a funnel plot was developed to describe the publication bias.

Twenty-three studies involving 30,688 participants were included. Meta-analysis results showed that age, body mass index (BMI), APACHE II score, renal insufficiency, digestive system diseases, hypoproteinemia, sepsis, and post-pyloric feeding, starting feeding within 48 h, feeding pattern, nutritional formula, sedative drugs, vasoactive drugs, use of more than two antibiotics, oral potassium preparation, mechanical ventilation, days of mechanical ventilation, length of ICU stay, and mortality were the influencing factors of enteral nutrition feeding intolerance in critically ill patients. The results of the sensitivity analysis showed that the direction of the pooled effect size did not change after excluding each study one by one, suggesting that the results of the meta-analysis were robust.

According to the influencing factors, medical staff can pay attention to the high-risk patients at ICU admission to reduce the risk of feeding intolerance.

Survivors of critical illness experience significant morbidity, reduced physiologic reserve, and long-term complications that negatively impact quality of life. Although rehabilitative treatments are beneficial during early recovery, there is limited evidence regarding effective multimodal rehabilitation, nutrition, and anabolic nutrient/agent strategies for improving long-term outcomes. This review discusses novel personalized rehabilitation, nutrition, and anabolic nutrient/agent (ie, creatine, β-hydroxy-β-methylbutyrate, testosterone) approaches that allow for precise exercise and nutrition prescription and have potential to improve patient care, address continued medical needs, and optimize long-term recovery. Continued research is needed to further evaluate effectiveness and implementation of these strategies throughout the continuum of care.

BackgroundProne ventilation improves lung function in patients with acute respiratory distress syndrome by enhancing oxygenation; however, managing enteral nutrition during prone ventilation is challenging due to body position changes.ObjectiveThe objective of the study was to assess the safety and efficacy of enteral nutrition during prone ventilation. A meta-analysis was conducted to evaluate the efficacy and safety of enteral nutrition in the prone position in critically ill ventilated patients.MethodsBy searching databases such as PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and WanFang Data, the relevant literature was retrieved from their inception to 24 December 2024. The Newcastle-Ottawa Scale was used to evaluate article quality. Egger's test was used to check for publication bias, and Review Manager 5.4 was used to conduct the analyses.ResultsAmong 81 publications, five studies with a total sample size of 319 were included in this study. Enteral nutrition in the prone position, compared with that in the supine position, was associated with a lower energy achievement rate (mean difference: -0.88; 95% confidence interval: -1.83 to 0.06; P < 0.00001), no significant difference in mortality (odds ratio: 1.11; 95% confidence interval: 0.65 to 1.88; P = 0.7), a greater incidence of ventilator-associated pneumonia (odds ratio: 2.11; 95% confidence interval: 1.12 to 3.96; P = 0.02), more frequent vomiting (odds ratio: 2.38; 95% confidence interval: 1.61 to 3.50; P < 0.0001), a greater gastric residual volume (odds ratio: 2.72; 95% confidence interval: 1.47 to 5.03; P = 0.001), and increased interruptions in enteral nutrition (odds ratio: 4.75; 95% confidence interval: 2.22 to 10.17; P < 0.0001). The Egger's test suggested no significant publication bias in the meta-analysis of mortality, gastric residual volume, adequate enteral nutrition achievement, and ventilator-associated pneumonia.ConclusionA greater gastric residual volume, more frequent vomiting, and greater incidences of ventilator-associated pneumonia and enteral feeding interruptions are linked to enteral nutrition during prone ventilation. There was no statistically significant difference in mortality between the prone and supine positions. However, the prone position showed a slight trend toward reducing energy achievement rates, although this difference was not statistically significant.Trial registration number: PROSPERO CRD: 42023441409.

On June 13, 2020, an explosion involving a liquefied natural gas (LNG) tanker truck occurred in eastern China. Fifteen patients with extremely severe burns (referred to as "June 13" patients) were treated in the burn-intensive care unit (ICU) joint ward within the general ICU.

A multidisciplinary treatment team comprising 129 doctors, 126 nurses, and 165 auxiliary staff members was assembled. Additionally, 15 burn and ICU experts from various regions of China joined us. After concluding the treatment, patient data were collected and analyzed. The differences in clinical data between the deceased and surviving patients were retrospectively compared. Subsequently, the clinical data of 177 non-"June 13" patients with total burned body surface area (TBSA) > 50 % treated in the burn department from 2016 to 2023 were collected to compare the efficacy of our multidisciplinary collaborative treatment model.

The average TBSA of 15 "June 13" patients was 85.07 ± 15.85 % (range 50-98 %). Among them, 11 patients had a TBSA greater than 90 %, with 6 exceeding 95 %. Seven patients succumbed to their injuries, while 8 patients survived. The incidence of severe complications, such as multiple organ failure (MOF) and fungal infections, was higher in the deceased group than in the survival group. The surviving patients exhibited larger burn wound areas repaired by skin grafting on the 30th and 60th days, with significantly less residual wound area than the deceased group. In comparison with the non-"June 13" patients, the "June 13" patients were notably older and had larger TBSA, as well as larger areas of third-degree TBSA and higher mean revised Baux scores. After 1:2 matching for revised Baux score, the "June 13" group underwent a significantly higher number of operations (p-value =0.007). The "June 13" group showed a lower mortality rate, although not statistically significant (20 % vs 55 %, p = 0.119; log-rank p = 0.059 for Kaplan-Meier curves).

Multidisciplinary collaboration, guided by a comprehensive treatment plan, may improve the management of patients with extensive burns. Timely and effective surgical management is crucial for reducing mortality and improving patient prognosis.

Optimal nutrition is associated with positive outcomes in critically ill children. In 2017, the Society of Critical Care Medicine (SCCM) and the American Society of Parenteral and Enteral Nutrition (ASPEN) updated guidelines for nutritional support for this population. However, implementation of these guidelines may be delayed due to clinical barriers. We aimed to assess our practice against the recommendations of the ASPEN guidelines, hypothesizing that caregiver bias and clinical factors may hinder their implementation in our pediatric intensive care unit (PICU).

We focused on two ASPEN recommendations: (1) feeding within 48 h (48H) of admission and (2) meeting two thirds of estimated caloric requirements after seven calendar days. All children aged 1 month to 16 years admitted to our PICU from July 2017 to January 2020 were eligible. Using a retrospective chart review, nutritional and clinical data were collected at the time of admission, at 48H, and 7 calendar days after admission.

A total of 533 patients were included. After 48H of admission to the PICU, 402 out of 533 (75.4%) patients received feeding. The following factors were associated with not reaching nutritional goals at 48H: invasive ventilation support, inotropic and vasoactive support, and extracorporeal life support. After 7 days, 95 out of 118 (80.5%) received two thirds of caloric needs. At 7 days, the main obstacle to meeting caloric goals was invasive ventilation.

In a representative tertiary PICU, barriers to meeting ASPEN nutritional recommendations included hemodynamic instability or invasive ventilator support, especially within the first 48H of admission.

Malnutrition remains a significant issue in children undergoing ECMO. This study aimed to investigate the effects of initiating enteral nutrition (EN) within 24 h on the adequacy of nutrient intake, nutritional status, anabolic metabolism, and inflammatory markers in children receiving ECMO.

This was a prospective observational cohort study, including children receiving ECMO therapy at the Children's Hospital of Chongqing Medical University of China from April 2018 to August 2024. Patients were divided into early EN (EEN) and late EN (LEN) groups based on whether effective EN was initiated within 24 h after the start of ECMO. T-tests or Mann-Whitney U and Chi-square tests were used to compare the clinical characteristics, serum total protein (TP), nutritional intake, serum cholinesterase (CHE), and C-reactive protein (CRP) levels between the two groups. Linear mixed-effects models (LME) were applied to assess the effect of EEN on changes in CRP and CHE levels over time during ECMO.

A total of 47 children were included in this study, with 24 patients (51.1%) successfully receiving EEN. The PRISM3 score was higher in the LEN group (P = 0.016). The majority of children in the EEN group had pneumonia or ARDS (P < 0.001). The average daily energy and protein intake, as well as their adequacy, was higher in the EEN group compared to the LEN group (P < 0.001), although the EEN group experienced more frequent interruptions in EN (P < 0.05). Serum TP levels in the EEN group were higher than those in the LEN group during the first 3 days of ECMO (P < 0.05). The median CHE levels were higher, and the median CRP levels were lower in the EEN group compared to the LEN group (P < 0.05). LME analysis showed a significant interaction effect between EEN and time on CRP and CHE levels (P < 0.001).

Successfully initiating EN within 24 h significantly improves the nutritional status of children receiving ECMO, promotes hepatic anabolic metabolism, and reduces inflammatory responses. This study provided new insights and data support for nutritional therapy strategies in children on ECMO.

Stroke is a leading cause of death and functional decline that places a significant burden on healthcare systems. Malnutrition is a critical clinical concern that complicates the condition of stroke patients and contributes to unfavorable outcomes. Dysphagia is the primary cause of malnutrition in the acute stage after stroke. Enteral nutrition (EN) has been employed to manage the nutritional status of stroke patients to prevent and treat malnutrition. Early EN (EEN) has been shown to reduce mortality and the prevalence of malnutrition while enhancing functional outcomes. In the majority of cases requiring nutritional support, nasogastric tube (NGT) placement is prioritized. However, under specific circumstances, direct enteral tube (DET) feeding that includes percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy (PEJ), offers distinct advantages, particularly for PEG. Compared to intermittent EN, continuous EN demonstrates better tolerance. An EN protocol providing sufficient nutrient supply and energy support can alleviate neurological deficits and reduce the severity of motor dysfunction in stroke patients, thereby improving their prognosis. Energy-rich formulations of EN and EEN may be associated with a lower incidence of stroke-associated pneumonia (SAP). However, the use of EN may lead to an increased incidence of digestive complications, and hyperglycemia. In this study, we reviewed the indications, opportunities, and management methods for EN application, along with the nutrient composition of nutritional protocols for stroke patients.

Spinal cord injury (SCI) is a devastating condition with a high burden of morbidity and mortality. National guidelines state that patients should not receive enteral feeding for 48 hours after inury, which may be detrimental if a patient experiences a hypercatabolic response to polytrauma. We conducted a systematic review of the benefits and harms of delayed enteral feeding in this population.

We searched MEDLINE, EMBASE and Cochrane CENTRAL for studies which had a time parameter as part of their evaluation of feeding in the acute phase of spinal cord injury in a critical care setting. Required outcomes for inclusion were neurological improvement, neurological complications, time spent in an ICU, time to ICU discharge, incidence of secondary complications, other adverse effects and mortality. Risk of bias was assessed with the Downs and Black checklist.

Four studies met the inclusion criteria. There was no high-quality evidence of worsened outcomes with earlier feeding compared to delayed enteral feeding. One study demonstrated that patients fed before 24 h in conjunction with a broader bundle of care had improved neurological outcomes compared to previous non-standardised practice. There was no evidence of difference in frequency of infections or mortality in early or late feeding groups.

We find no clear evidence of increased risk of harm from earlier enteral feeding strategies, nor clear evidence of benefit of earlier feeding as an isolated intervention.

Medical Nutrition Therapy (MNT) is a key component of treatment in intensive care units (ICU) and plays a crucial role in the prognosis of critically ill patients. An individualized nutrition strategy is essential to meet the specific needs of critically ill patients and to minimize potential complications.Recommendations for MNT differ between the guidelines of the German Society for Nutritional Medicine (DGEM), the European Society for Clinical Nutrition and Metabolism (ESPEN), and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), making its implementation in clinical practice challenging. Therefore, the first part of this article provides a pragmatic summary of the current recommendations for everyday clinical practice. The second part focuses on recent data and how these might influence current paradigms of MNT for critically ill patients, with particular emphasis on phase-appropriate macronutrient delivery and combinations of nutrition with other interventions.

To investigate the risk factors and their diagnostic efficacy for postoperative intestinal mucosal barrier dysfunction (IBD) following severe traumatic brain injury (sTBI).

There were 140 patients with sTBI enrolled in this study. Univariate and multivariate logistic regression analyses were conducted to assess the relationship between the clinical data and postoperative IBD in sTBI patients and determine the independent risk factors. The diagnostic efficacy of each risk factor was evaluated using the receiver operating characteristic curve and the area under the curve.

According to the diagnostic criteria for IBD, the 140 enrolled patients were classified into the IBD group (n = 60) and the non-IBD group (n = 80). The levels of intraoperative initial intracranial pressure (iICP) of patients with IBD were significantly higher compared with those of patients without IBD (P < 0.001). Furthermore, intraoperative iICP presented high diagnostic efficacy for postoperative IBD (area under the curve = 0.91, 95% confidence interval 0.85-0.96, P < 0.001). Patients with higher intraoperative iICP were more prone to suffering unfavorable neurological outcomes.

Intraoperative iICP could act as an independent and quantifiable predictor with high diagnostic efficacy for IBD in patients with sTBI after emergency surgery.

It remains unclear if early enteral nutrition benefits patients with circulatory shock, particularly in those with prolonged use of vasopressors. This study aimed to assess the association between early enteral nutrition and clinical outcomes in patients with circulatory shock and whether the duration of circulatory shock (transient or persistent) impacts this association.

Using data from a multicenter, cluster-randomized controlled trial, this secondary analysis involved patients with baseline circulatory shock as defined by a cardiovascular Sequential Organ Failure Assessment score of two or more. Patients were dichotomized into transient or persistent circulatory shock depending on the duration, while transient circulatory shock was defined by the resolution of shock within the first day of enrollment. Early enteral nutrition was defined as the initiation of enteral nutrition within 48 h after intensive care unit admission. The association between early enteral nutrition and a composite outcome (presence of any organ failure on study day 10 or 28-day mortality) was investigated by multivariable and propensity-score-weighted multivariable logistic regression analyses.

Seven hundred and eighty-five patients were included in the analysis, and early enteral nutrition was administered to 385 patients (49.0 %) in the whole study cohort. In patients with transient circulatory shock (n = 527), 221 patients (41.9 %) received early enteral nutrition, and in those with persistent circulatory shock (n = 258), 164 patients (63.6 %) did so. For the overall cohort, there was no difference in the incidence of primary composite outcome between early enteral nutrition and 'no early enteral nutrition ' groups (adjusted odd ratio 0.84, 95 % confidence interval 0.60-1.18) after adjustment for potential confounders. In patients with transient circulatory shock, receipt of early enteral nutrition, compared to no early enteral nutrition, was significantly associated with reduced incidence of the composite outcome (adjusted odd ratio 0.63, 95 % confidence interval 0.41-0.95, p = 0.027). On the contrary, there is no association between early enteral nutrition and the incidence of the composite outcome in patients with persistent circulatory shock (adjusted odd ratio 1.28, 95 % confidence interval 0.64-2.58, p = 0.485). The results of propensity-weighted multivariable analysis conform to the primary analysis.

Early enteral nutrition was associated with improved clinical outcomes among patients with circulatory shock that resolved within the first day. RESEARCH REGISTRATION UNIQUE IDENTIFYING NUMBER (UIN) OF THE ORIGINAL NEED TRIAL: ISRCTN Registry, Registry number: ISRCTN12233792.

Autoimmune encephalitis (AE) is a severe neurological disease often accompanied by consciousness disturbances, severe swallowing difficulties, and gastrointestinal dysfunction, increasing the risk of malnutrition. However, the optimal caloric intake target during the acute phase of AE remains unclear.

This study aims to evaluate the impact of caloric intake on short-term clinical outcomes in AE patients, specifically focusing on the improvement in Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores, to provide recommendations for nutritional support during the acute phase.

A retrospective study analyzed clinical data from 128 adult AE patients requiring nutritional support, admitted to West China Hospital, Sichuan University, from January 2020 to January 2024. Patients were categorized into low-calorie intake (below 70% of requirements), standard-calorie intake (70-100% of requirements), and high-calorie intake (above 100% of requirements) groups. Multivariate linear and logistic regression models were used to quantify the associations.

Higher caloric intake was significantly associated with improved CASE scores (β = 8.58, SE = 3.75, 95% CI = 1.14 to 16.03, p = 0.02). Low caloric intake negatively impacted the improvement of CASE scores (p = 0.049), particularly in seizures and speech problems. The low-calorie intake group had significantly longer hospital stays and nutrition therapy durations (45.79 ± 30.98 days, p < 0.01; 40.39 ± 31.92 days, p = 0.02).

Adequate caloric intake has a significant positive impact on the short-term clinical outcomes of AE patients, suggesting that meeting or exceeding caloric requirements may promote neurological recovery in AE patients. Future prospective studies are needed to validate these findings and further optimize nutritional support strategies.

Enteral nutrition (EN) has been reported to have some physiological importance for critically ill patients. However, the advantage of EN over parenteral nutrition remains controversial in recent paradigms. To maximize the benefits and efficiency of EN, implementing measures based on comprehensive evidence is essential. Here, we systematically reviewed EN-related studies and integrated them into the best and most up-to-date EN practices. We extracted studies from 13 systematic reviews during the development of Japanese Critical Care Nutrition Guidelines, summarizing findings on the assessment of enteral feeding intolerance (EFI), the timing of EN, formula composition and nutrients, and method of administration in critically ill adult patients. Multifaceted EFI assessment may be needed in patients for high-risk patients. Early EN may reduce infectious complications, and initiating EN even earlier may offer an additional advantage. High protein intake (≥1.2 g/kg/day) could maintain muscle mass and physical function without increasing gastrointestinal complications. Probiotics, prebiotics, and synbiotics may serve as beneficial options for preventing infection and gastrointestinal complications, although their efficacy depends on the strains, types, and combinations used. For patients with EFI, post-pyloric feeding could be an effective approach, while intermittent feeding may be a safer approach. Both methods should be utilized to achieve nutritional targets. Integrating these nutritional interventions into EN strategies may help maximize their effectiveness and minimize complications. However, careful consideration regarding timing, dosage, nutrient selection, administration methods, and patient selection is required.

Acute kidney injury (AKI) is a complex clinical syndrome characterized by a rapid decline in kidney function, often resulting in complex metabolic and hormonal derangements. A major concern in managing AKI patients is the development of protein energy wasting (PEW), a condition marked by loss of lean body mass and negative impact on overall health outcomes. Additionally, the need of Kidney Replacement Therapy (KRT) for the most severe forms of AKI may further increase the risk of PEW, with a substantial impact on fluid and metabolic balance. Adequate nutritional support is crucial in the management of AKI, as it plays a pivotal role in muscle mass preservation, morbidity reduction and recovery of renal function. This paper aims to evaluate the current evidence regarding nutritional strategies in AKI patients, focusing on energy and protein requirements, timing and route of nutritional intervention, and impact of individualized nutrition plans on PEW prevention and management.

This study aims to examine the efficacy of gastric tube decompression in rapid tip positioning during bedside blind insertion of nasoenteric tubes.

Between August 2023 and July 2024, patients who were critically ill in the emergency intensive care unit of a tertiary hospital in Beijing who required nasoenteric tube placement were enrolled in this study. Gastric tube decompression was used to facilitate the tip positioning of nasoenteric tubes inserted blindly (without direct visualization), at the bedside. The accuracy of this method was verified by comparing the results to the "gold standard" of abdominal X-ray imaging. Consistent results indicated successful positioning. Additionally, the number of positioning attempts, time taken, and associated adverse events were recorded as outcome indicators.

A total of 55 patients who were critically ill were included in the study, achieving a positioning conformity rate of 98.18% (54/55). The first-time positioning conformity rate was 94.55% (52/55). The median time for positioning attempts was 21 minutes (18, 28 minutes). The sensitivity was recorded at 100%, and no related adverse events were reported.

Gastric tube decompression can rapidly and accurately determine the position of the nasoenteric tube tip, providing a safe and convenient method with a high accuracy rate. This technique enhances the safety of long-term nasoenteric tube placement in patients who are critically ill and enhances the efficiency of blind nasoenteric tube insertion.

This study planned to analyse the association between ondansetron use within 24 hours before intensive care unit (ICU) admission to within 48 hours after ICU admission and the risk of sepsis in ICU patients.

A cohort study.

Data of 65 366 participants in Medical Information Mart for Intensive Care IV from ICU in the Beth Israel Deaconess Medical Center.

Sepsis was the primary outcome, which indicated patients with documented or suspected infection and acute change in total Sequential Organ Failure Assessment (SOFA) score ≥2 points. In-hospital mortality was the secondary outcome.

There were 6737 patients with early ondansetron use. In total, 1646 patients suffered sepsis. According to the data from multivariate cox regression model, compared with participants without early ondansetron use, the risk of sepsis was reduced in participants with early ondansetron use relative to those without HR (HR=0.84, 95% CI: 0.76 to 0.93). The risk of in-hospital mortality was reduced in those with early ondansetron use (HR=0.63, 95% CI: 0.55 to 0.72). Subgroup analysis revealed that the association between early ondansetron use and decreased risk of sepsis was significant in participants aged <65 years, men, not complicated with trauma, no surgery, systemic inflammatory response syndrome ≥2, Charlson Comorbidity Index ≥2, with ventilation use, without antibiotics use or without insulin use. In both patients with SOFA <3 or SOFA ≥3, early ondansetron use was correlated with a reduced risk of sepsis.

Patients with early ondansetron use had lower odds of experiencing sepsis than patients without early ondansetron use, which might provide a reference for the management of sepsis in ICU patients.

Background and Aim: International guidelines recommend early enteral nutrition (EEN) for critically ill patients. However, evidence supporting the optimal timing of EN in patients diagnosed with cardiogenic shock (CS) is lacking. As such, this study aimed to compare the clinical outcomes and safety of EEN versus delayed EN in patients diagnosed with CS. Methods: This retrospective cohort study was conducted using data from the Medical Information Mart for Intensive Care IV version 2.2 database. Patients who received EN within 2 days of admission were assigned to the EEN group. A 1:1 propensity score-matched (PSM) analysis was performed to control for bias in baseline characteristics and ensure the reliability of the results. To exclude the impact of confounders, an adjusted proportional hazards regression model was used to verify the independence between EEN and survival outcomes. Results: Of 1846 potentially eligible patients, 1398 received EEN and 448 received delayed EN. After 1:1 PSM, 818 patients were assigned to the EEN (n = 409) and delayed EN (n = 409) groups. Regarding cumulative survival, patients with CS receiving EEN experienced better 30-, 90-, and 180-day survival outcomes than the delayed EN group (hazard ratio [HR] 0.803 [95% confidence interval [CI] 0.647-0.998], p=0.045; HR 0.729 [95% CI 0.599-0.889], p=0.001; and HR 0.778 [95% CI 0.644-0.938], p=0.008, respectively). After adjusting for confounders, EEN was found to be independently associated with survival outcomes. Moreover, EEN did not increase the risk(s) for ileus, aspiration pneumonia, or gastrointestinal bleeding. Patients who received delayed EN experienced longer hospital stays than those receiving EEN (17 days [interquartile range [IQR] 10-25] versus 12 days [IQR 7-19 days], respectively; p < 0.001). Conclusion: EEN was not associated with harm, but rather with improved survival outcomes in patients diagnosed with CS. Further studies are required to verify these findings.

Critical illness is a complex condition that can have a devastating impact on health and quality of life. Nutritional support is a crucial component of critical care that aims to maintain or restore nutritional status and muscle function. A one-size-fits-all approach to the components of nutritional support has not proven beneficial. Recent randomized controlled trials challenge the conventional strategy and support the safety and potential benefits of below-usual calorie and protein intakes at the early, acute phase of critical illness. Further research is needed to define optimal nutritional support throughout the intensive care unit stay. Individualized nutritional strategies relying on risk assessment tools or biomarkers deserve further investigation in rigorously designed, large, multicenter, randomized, controlled trials. Importantly, although nutritional support is crucial, it might not be sufficient to enhance the recovery of critically ill patients. Thus, achieving the greatest efficacy may require individualized nutritional support combined with early, prolonged physical rehabilitation within a multimodal, holistic care program throughout the patient's recovery journey.

Malnutrition is a well-studied and significant prognostic risk factor for morbidity and mortality in critically ill perioperative patients. Common nutrition myths in the critically ill may prevent early, consistent, and adequate delivery of enteral nutrition. We outlined 9 common intensive care unit (ICU) nutrition misconceptions and our recommendations to optimize enteral nutrition in critically ill patients based on the review of available literature. Our approach is to treat every patient admitted to the ICU as at risk for malnutrition and to initiate enteral nutrition upon admission in the absence of contraindications. Early enteral nutrition via the gastric route is more beneficial than delaying feeding while awaiting small bowel access and daytime-intermittent nutrition support can safely be initiated over continuous feeding. Gastric residual volumes to assess feeding tolerance should no longer be routinely measured. For perioperative nutrition, we recommend continuing enteral nutrition for most patients with secure airways undergoing anesthesia and resuming nutrition within 24 h of abdominal surgery; even patients with open abdomens can be safely fed in the absence of bowel injury. Critically ill patients who are proned, paralyzed, and on vasopressors can usually continue enteral nutrition. Finally, continuing enteral nutrition before extubation may optimize nutrition without compromising extubation success. In this review, we highlight several common misconceptions regarding ICU nutrition that may prevent achieving nutrition goals and subsequently lead to increased malnutrition, morbidity, and mortality. This knowledge may contribute to increased implementation of early and consistent enteral nutrition strategies to improve outcomes in critically ill adult patients.

With a decrease in mortality of critically ill patients in recent years, intensive care medicine research has shifted its focus on functional impairments of intensive care units (ICU) survivors. ICU survivorship is characterized by long-term impairments of cognition, mental health, and physical health. Since 2012, these impairments have been summarized with the umbrella term Post-Intensive Care Syndrome (PICS). Mental health impairments frequently entail new are aggravated symptoms of depression, anxiety, and posttraumatic stress disorder. Beyond impairments in the three PICS domains, critical illness survivors frequently suffer from chronic pain, dysphagia, and nutritional deficiencies. Furthermore, they have a higher risk for osteoporosis, bone fractures, and diabetes mellitus. Taken together, these sequelae reduce their health-related quality of life. Additionally, ICU survivors are challenged by social problems such as isolation, economic problems such as treatment costs and lost earnings, and return to previous employment. Yet, patients and caregivers have described post-ICU care as inadequate and fragmented. ICU follow-up clinics could improve post-ICU care, but there is insufficient evidence for their effectiveness. Thus far, large high-quality trials with multicomponent and interdisciplinary post-ICU interventions have mostly failed to improve patient outcomes. Hence, preventing PICS and minimizing risk factors by optimizing ICU care is crucial, e.g. by implementing the ABCDE bundle. Future studies need to identify effective components of post-ICU recovery interventions and determine which patient populations may benefit most from ICU recovery services.

Nutritional support is crucial in critically ill patients to enhance recovery, reduce infections, and improve outcomes. This meta-analysis compared early enteral nutrition (EEN) and early parenteral nutrition (EPN) to evaluate their efficacy in adult critically ill patients.

A systematic review of 14 studies involving 7618 patients was conducted, including randomized controlled trials, prospective cohorts, and retrospective analyses. The primary outcomes were mortality and infectious complications, while secondary outcomes included intensive care unit length of stay (ICU-LOS), hospital length of stay (H-LOS), mechanical ventilation days, and gastrointestinal (GI) complications.

The results showed no significant difference in mortality between EEN and EPN (OR 1.03, 95% CI 0.93-1.14). EEN reduced bloodstream infections (OR 0.73, 95% CI 0.57-0.93), ICU-LOS (MD -0.18 days, 95% CI -0.33 to -0.04), and H-LOS (MD -1.15 days, 95% CI -1.38 to -0.93). However, EEN was associated with higher GI complications, such as vomiting and diarrhea (OR 2.25, 95% CI 1.97-2.58), while mechanical ventilation days showed no significant difference.

These findings support prioritizing EEN in critically ill patients with functional gastrointestinal systems to improve infection control and recovery while emphasizing the importance of careful monitoring to mitigate gastrointestinal complications.

Traumatic brain injury (TBI) is a prevalent disease that poses a significant threat to global public health. Digestive dysfunction, as a common complication, is of particular importance to understand its pathogenesis, diagnostic criteria, and relevant treatment strategies. TBI can affect digestive function through inflammatory immune responses, the enteric nervous system, and hormonal levels. Furthermore, TBI can also impact neurologic recovery through bidirectional communication along the brain-gut axis. Therefore, this article aims to summarize the underlying mechanisms and further explore individualized feeding strategies, therapeutic approaches, long-term prognosis for TBI patients, as well as recent advancements in related technologies. Further understanding of the pathogenesis of digestive system dysfunction after TBI on the basis of the interaction of gut-brain axis is conducive to more future therapies to treat TBI and improve the long-term prognosis of patients through improving digestive function, and achieve good clinical efficacy.

Patients with severe respiratory failure have high mortality and need various interventions. However, the impact of intensivists on treatment choices, patient outcomes, and optimal intensivist staffing patterns is unknown. In this study, we aimed to evaluate treatments and clinical outcomes for patients at board-certified intensive care training facilities compared with those at non-certified facilities.

This retrospective cohort study used Japan's nationwide in-patient database from 2016 to 2019 and included patients with non-operative severe respiratory failure who required mechanical ventilation for over 4 days. Treatments and in-hospital mortality were compared between board-certified intensive care facilities requiring at least one intensivist and non-certified facilities using propensity score matching.

Of the 66,905 patients in this study, 30,588 were treated at board-certified facilities, and 36,317 were not. The following differed between board-certified and non-certified facilities: propofol (35% vs. 18%), dexmedetomidine (37% vs. 19%), fentanyl (50% vs. 20%), rocuronium (8.5% vs. 2.6%), vecuronium (1.9% vs. 0.6%), noradrenaline (35% vs. 19%), arginine vasopressin (8.1% vs. 2.0%), adrenaline (2.3% vs. 1.0%), dobutamine (8.7% vs. 4.8%), phosphodiesterase inhibitors (1.0% vs. 0.3%), early enteral nutrition (29% vs. 14%), early rehabilitation (34% vs. 30%), renal replace therapy (15% vs. 6.7%), extracorporeal membrane oxygenation (1.6% vs. 0.3%), critical care unit admission (74% vs. 30%), dopamine (9.0% vs. 15%), sivelestat (4.1% vs. 7.0%), and high-dose methylprednisolone (13% vs. 15%). After 1:1 propensity score matching, the board-certified group had lower in-hospital mortality than the non-certified group (31% vs. 38%; odds ratio, 0.75; 95% confidence interval, 0.72-0.77; P < 0.001). Subgroup analyses showed greater benefits in the board-certified group for older patients, those who required vasopressors on the first day of mechanical ventilation, and those treated in critical care units.

Board-certified intensive care training facilities implemented several different adjunctive treatments for severe respiratory failure compared to non-board-certified facilities, and board-certified facilities were associated with lower in-hospital mortality. Because various factors may contribute to the outcome, the causal relationship remains uncertain. Further research is warranted to determine how best to strengthen patient outcomes in the critical care system through the certification of intensive care training facilities.

This study aims to assess the proficiency of nurses in the neurology department in managing patients with indwelling gastrointestinal canal.

Many critically ill patients in neurology departments require the placement of nasoenteric tubes to provide enteral nutrition. However, in clinical practice, there exists considerable variability in nurses' competencies regarding the management of patients with nasoenteric tubes. A thorough understanding of the challenges nurses face throughout the entire process of nasoenteric tube care and the development of targeted improvement measures are crucial for delivering enhanced patient care and facilitating patient recovery.

A qualitative interview study.

From August to October 2023, 11 neurological nurses were recruited offline in three hospitals for semi-structured and in-depth interviews. The data analysis uses the KJ method to summarize and classify the themes from the semi-structured interview results, and then organize the themes into a coherent visual and logical path. The COREQ list is used.

The researchers conducted semi-structured interviews with 11 neurology nurses from three hospitals using a purposive sampling method, of which 64% of the participants were female and 36% were male; the average age was 38.27 ± 7.85 years; 27% from the Department of Neurology, 73% from the Department of Neurosurgery; junior professional titles accounted for 18%, intermediate professional titles accounted for 64%, senior professional titles accounted for 18%; 27% of the subjects were head nurses and 73% were nurses. The study identified 5 themes: (1) Preparation and evaluation before intubation; (2) Enhancement of intubation success rates; (3) Prevention of complications; (4) Management of complications and emergencies; (5) The acquisition of relevant knowledge and experience. In clinical practice, the bedside blind insertion technique is random and has not yet formed a unified standard, and the specific operation details and techniques need to be further improved.

Disparities exist in the nursing capabilities of neurology nurses due to variations in their knowledge and experience regarding gastrointestinal canal management.

Racial and ethnic disparities in malnutrition are well-known, but it is unknown if there are disparities in early nutrition delivery for intensive care unit (ICU) patients, which is associated with better outcomes. We investigated the timing of enteral nutrition (EN) and parenteral nutrition (PN) initiation in the ICU, examining for racial differences.

Using the eICU-Collaborative Research Database (eICU-CRD) from 2014 to 2015, we analyzed patients eligible for EN and PN from 208 hospitals. EN and PN delivery was captured through intake/output entries. Exclusions included pre-existing EN/PN and short (<4 d) mechanical ventilation. Severity-of-illness was assessed using the sequential organ failure assessment (SOFA) score. Self-identified race was defined as the primary exposure, and Cox proportional hazards models were used to examine the association between race and time to EN and PN initiation, adjusting for patient, ICU, and hospital characteristics.

Of 1914 patients from 14 hospitals with EN data (5.3% Black, 42.4% female, median age 65 y), 888 received EN. Among Black and White patients, the median [Q1, Q3] time from mechanical ventilation to EN was 1.5 [1.0, 2.8] d. Race was not associated with time until EN initiation (hazard ratio = 0.961, 95% confidence interval 0.693, 1.333). Rather, other variables including sex, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in EN initiation. Among 31,551 patients from 59 hospitals with PN data (11.3% Black, 45.1% female, median age 67 y), 1140 received PN, with a median [Q1, Q3] time to PN initiation of 7.4 [4.2, 12.4] d amongst Black and White patients. Race was not associated with time until PN initiation (hazard ratio = 1.095, 95% confidence interval = 0.901, 1.331). Instead, sex, body mass index, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in PN initiation.

Disparities in EN and PN delivery in the eICU-CRD dataset from 2014 to 2015 were not associated with race, but rather with sex, body mass index, SOFA, hospital characteristics and ICU unit type. Further investigations using more current data are needed.

Malnutrition is a highly prevalent complication in patients with traumatic brain injury (TBI), and it is closely related to the prognosis of patients. Accurate identification of patients at high risk of malnutrition is essential. Therefore, we analyzed the risk factors of malnutrition in patients with TBI and developed a model to predict the risk of malnutrition. A retrospective collection of 345 patients with TBI, and they were divided into malnutrition and comparison groups according to the occurrence of malnutrition. Univariate correlation and multifactor logistic regression analyses were performed to determine patients' malnutrition risk factors. We used univariate and logistic regression (forward stepwise method) analyses to identify significant predictors associated with malnutrition in patients with TBI and developed a predictive model for malnutrition prediction. The model's discrimination, calibration, and clinical utility were evaluated using the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA). A total of 216 patients (62.6%) developed malnutrition. Multifactorial logistic regression analysis showed that pulmonary infection, urinary tract infection, dysphagia, application of NGT, GCS score ≤ 8, and low ADL score were independent risk factors for malnutrition in patients with TBI (P < 0.05). The area under the curve of the model was 0.947. Calibration plots showed good discrimination of model calibration. DCA showed that the column line plot models were all clinically meaningful when nutritional interventions were performed over a considerable range of threshold probabilities (0-0.98). Malnutrition is widespread in patients with TBI, and the nomogram is a good predictor of whether patients develop malnutrition.

Transcutaneous Electrical Acupoint Stimulation (TEAS) is a technique that involves stimulating specific acupoints on the body with electrical currents. It may regulate nerve excitability and improve nerve function. This study aimed to assess the impact of TEAS on gastrointestinal motility, nutrition, and immune function in patients post cerebrovascular accident surgery in the intensive care unit (ICU).

A randomized controlled trial included 300 post-cerebrovascular surgery patients at Lishui Central Hospital (January 2021-June 2023). Patients were randomly assigned to TEAS or control groups in a 1:1 ratio. The TEAS group received TEAS at bilateral Zusanli (ST36), Shangjuxu (ST37), Tianshu (ST25), Neiguan (PC6), and Hegu (LI4) according to the International Acupuncture Point Code, plus standard care. The control group received routine enteral nutrition and sham TEAS. Nutritional, immune, and gastrointestinal motility indicators were compared.

A randomized controlled trial involving 300 post-surgery patients compared TEAS to sham TEAS, demonstrating significant enhancements (p < 0.05) in immune function and gastrointestinal motility. Compared to the control group, the TEAS group showed significant improvements in the patient's serum nutritional levels (prealbumin, albumin, hemoglobin, and total protein), immune status (IgG, IgA, IgM, and CD4+/CD8+), gastrointestinal motility (daily gastric residual volume, time to achieve target feeding volume, time for nutritional fluid to meet standards, time to first bowel movement, time to first passage of activated charcoal stool, time to reach the defecation volume), and overall condition (the scores of clinical scales and ICU stay duration) (p < 0.05). The TEAS group also experienced a significantly lower incidence of adverse events (p < 0.05).

Early TEAS intervention positively impacted recovery, shortened ICU stay, and improved outcomes in patients post cerebrovascular accident surgery.

Sepsis is the body's extreme response to an infection leading to organ dysfunction. Sepsis-related acquired weakness (SAW), a critical illness closely related to metabolic disorders, is characterized by generalized sepsis-induced skeletal muscle weakness, mainly manifesting as symmetrical atrophy of respiratory and limb muscles. Muscle accounts for 40% of the body's total mass and is one of the major sites of glucose and energy absorption. Diet affects skeletal muscle metabolism, which further impacts physiology and signaling pathways. The ketogenic diet (KD) is a high-fat, low-carbohydrate diet that has shown benefits in patients with a variety of neuromuscular disorders. Patients with SAW are in a hypermetabolic state and can consume approximately 1% of total body muscle mass in a day. Due to the decreased total body energy expenditure secondary to starvation, skeletal muscles enter a low metabolic state, with reduced gluconeogenesis and protein consumption and elevated levels of ketone bodies. The latest research suggests that KD may be a new strategy for SAW prevention and treatment, but its mechanism is still unclear.

Our article aims to explore the effect and mechanism of KD on SAW. And we hope that our review will inspire further research on the KD and foster the exploration of novel strategies for combating SAW.

Search medical databases and related academic websites, using keywords such as "Sepsis-related acquired weakness," "ketogenic diet," and "skeletal muscle," and select representative literature. Using the method of induction and summary, analyze the effect and mechanism of KD on SAW.

Compared with early nutrition, KD has a more protective effect on SAW, but its mechanism is complex. Firstly, KD can alter energy metabolism substrates to affect SAW's energy metabolism; Secondly, KD can directly act as a signaling molecule to improve mitochondrial function in skeletal muscle and stimulate skeletal muscle regeneration signaling molecules; Thirdly, KD can affect the gut microbiota to exert anti-inflammatory effects, enhance immunity, and thus protect SAW.

KD has a protective effect on SAW, which includes improving energy metabolism, stimulating muscle regeneration signals, optimizing gut microbiota composition, and reducing inflammation and oxidative stress.

Evidence on the benefits of fiber-supplemented enteral nutrition (EN) in critically ill patients is inconsistent, and critical care nutrition guidelines lack recommendations based on high-quality evidence. This systematic review and meta-analysis (SRMA) aims to provide a current synthesis of the literature on this topic.

For this SRMA of randomized controlled trials (RCT), electronic databases (MEDLINE, EMBASE, CENTRAL) were searched systematically from inception to January 2024 and updated in June 2024. Trials investigating clinical effects of fiber-supplemented EN versus placebo or usual care in adult critically ill patients were selected. Two independent reviewers extracted data and assessed the risk of bias of the included studies. Random-effect meta-analysis and trial sequential analysis (TSA) were conducted. The primary outcome was overall mortality, and one of the secondary outcomes was diarrhea incidence. Subgroup analyses were also performed for both outcomes.

Twenty studies with 1405 critically ill patients were included. In conventional meta-analysis, fiber-supplemented EN was associated with a significant reduction of overall mortality (RR 0.66, 95% CI 0.47, 0.92, p = 0.01, I2 = 0%; 12 studies) and diarrhea incidence (RR 0.70, 95% CI 0.51, 0.96, p = 0.03, I2 = 51%; 11 studies). However, both outcomes were assessed to have very serious risk of bias, and, according to TSA, a type-1 error cannot be ruled out. No subgroup differences were found for the primary outcome.

Very low-certainty evidence suggests that fiber-supplemented EN has clinical benefits. High-quality multicenter RCTs with large sample sizes are needed to substantiate any firm recommendation for its routine use in this group of patients. PROSPERO registration number: CRD42023492829.

Nutritional therapy is an important component of intensive care. We investigated the associations of nutritional therapy in the acute phase of severe COVID-19 with the long-term outcomes of post-intensive care syndrome (PICS) and post-COVID-19 conditions.

A questionnaire on the health status after COVID-19 was sent to patients 1 year after infection and PICS was evaluated. Total energy and protein intakes during the first week after admission to the intensive care unit (ICU) were calculated. The primary endpoint was a decrease in quality of life (QOL) defined by EuroQol5-dimensions 5-level (EQ5D5L) <0.8. A multivariable regression analysis was used to examine.

A total of 220 ICU patients were included in this study. Median total energy and protein intakes were 65.1 kcal/kg/week and 3.3 g/kg/week, respectively. Total energy and protein intakes were associated with EQ5D5L scores (energy: unit odds ratio 0.98 [0.97-0.99], p value <0.01; protein: unit odds ratio 0.72 [0.59-0.87], p value <0.01). Insufficient total energy and protein intakes were associated with malaise, arthralgia, myalgia, palpitations, sleep disturbance, and muscle weakness.

Poor nutrition during the first week after ICU admission was associated with a decreased QOL 1 year after. These nutrition shortages were also associated with an increased risk of developing PICS, post-COVID-19 conditions, which may contribute to decreased QOL.

Nutritional therapy is an important component of intensive care. We investigated the associations of nutritional therapy in the acute phase of severe COVID-19 with the long-term outcomes of post-intensive care syndrome (PICS) and post-COVID-19 conditions.

A questionnaire on the health status after COVID-19 was sent to patients 1 year after infection and PICS was evaluated. Total energy and protein intakes during the first week after admission to the intensive care unit (ICU) were calculated. The primary endpoint was a decrease in quality of life (QOL) defined by EuroQol5-dimensions 5-level (EQ5D5L) <0.8. A multivariable regression analysis was used to examine.

A total of 220 ICU patients were included in this study. Median total energy and protein intakes were 65.1 kcal/kg/week and 3.3 g/kg/week, respectively. Total energy and protein intakes were associated with EQ5D5L scores (energy: unit odds ratio 0.98 [0.97-0.99], p value <0.01; protein: unit odds ratio 0.72 [0.59-0.87], p value <0.01). Insufficient total energy and protein intakes were associated with malaise, arthralgia, myalgia, palpitations, sleep disturbance, and muscle weakness.

Poor nutrition during the first week after ICU admission was associated with a decreased QOL 1 year after. These nutrition shortages were also associated with an increased risk of developing PICS, post-COVID-19 conditions, which may contribute to decreased QOL.

Enteral nutrition (EN) is essential for management of hepatic lipidosis (HL) in cats.

To determine if time to start of EN and other clinicopathologic variables are associated with outcome in cats with HL.

Forty-eight cats with HL.

Retrospective study. Information retrieved from medical records and client communications included clinicopathologic findings, time to start of EN, initial % of resting energy requirements provided, type of feeding tube, duration of hospitalization, and 3-month survival. Variables were compared between surviving and nonsurviving cats and between cats fed ≤12 hours and >12 hours after hospital admission. Multivariable statistical testing was performed to further investigate variables of interest.

Seventeen of 25 (68%) cats fed ≤12 hours and 13 of 23 (57%) of cats fed >12 hours after hospital admission survived (P = .55). Only increasing age (odds ratio [OR], 1.313; 95% confidence interval [CI], 1.032-1.671; P = .03) and the presence of ascites (OR, 6.415; 95% CI, 1.354-30.395; P = .02) were associated with death in multivariable analysis. Hospitalization duration (median, interquartile range [IQR]) was shorter in cats fed >12 hours (2.8 days; IQR, 2.1-3.8 days) as compared with cats fed ≤12 hours (4.8 days; IQR, 3.6-6.2 days) after hospital admission (P < .001).

An initial stabilization period before EN introduction does not decrease survival or increase duration of hospitalization in cats with HL.