Ensuring Optimal Survival and Post-ICU Quality of Life in High-Risk ICU Patients: Permissive Underfeeding Is Not Safe!

Abstract

Great controversy has arisen recently between two differing opinions regarding optimal feeding in the ICU. Traditionally, it has been advocated that patients receive 80% of full calorie and protein (1.2-2.0 g/kg/d) feeds in the first week of ICU to optimize outcomes(1). However, a number of recent trials have advocated for “trophic feeding” or intentional underfeeding in the first ICU week being equally efficacious and perhaps beneficial (2-4). However, it is intuitive to most ICU practitioners that “all ICU patients are not created equal” and undoubtedly “one size does not fit all”. This concept is well described, in the article by Wei et al in this issue of Critical Care Medicine(5). The authors of this manuscript demonstrate that in high-risk ICU patients (mechanically ventilated > 8 days) receiving low nutritional adequacy in the first week of ICU stay ( 80% of calorie needs) after adjusting for key covariates.