Quest for the best : Safety and optimization of nutrition therapy during critical illness and convalescence

Summary

In the past, nutritional support in critically ill patients was regarded as exogenous fuel to preserve lean body mass and replace oral intake in those unable to eat. However, more recently, this strategy has evolved to nutritional therapy, in which nutrition helps to attenuate catabolism (and thus reduce muscle wasting) and maintain nutritional status to improve clinical outcomes. There is increasing evidence for time- and dose-dependent (and thus patient-targeted) nutrition – there is no “one size fits all”. Critically ill patients preferably receive nutritional support matching their metabolic needs in the ICU and post-ICU period. However, this is complex as patients′ caloric and macronutrient (such as protein) requirements vary significantly throughout their ICU journey and formal guidelines for the dynamic nutritional targets of (particularly post-)ICU patients still need to be developed. Therefore, this thesis aimed to increase knowledge about the nutritional journey of patients during the several (metabolic) phases of critical illness, with the ultimate goal to improve current nutritional strategies and prevent adverse effects.