ESPEN 2018 – When it comes to nutrition, ICU recovery begins at admission: US physician

03 Sep 2018 --- Intensive care unit (ICU) recovery begins at ICU admission, and nutrition plays a vital role in this. As such, the medical nutrition industry should be investing further in research and product development into tailored protein and micronutrient solutions that will support patients during their hospital stay and beyond. This is according to Dr. Paul Wischmeyer, who presented at this year’s European Society for Clinical Nutrition and Metabolism (ESPEN) Congress in Madrid, Spain.

“It is essential to realize that our responsibilities as ICU caregivers don’t just involve what happens to the patient while they are in intensive care,” Wischmeyer tells NutritionInsight following his presentation on nutritional interventions to support muscle mass in ICU patients, during a satellite symposium program organized by Abbott Nutrition Health Institute. Wischmeyer is a perioperative, critical care and nutrition physician focused on patient care and research to help patients prepare for and recover from surgery and major or critical illnesses.

“We have now discovered that, [despite that] we are markedly reducing the death rate in hospital admissions, the quality of life our patients are facing is seriously compromised after they leave the ICU, with 60 to 80 percent of ICU patients on a ventilator suffering marked quality of life deficits,” Wischmeyer says. “We must not only be thinking about the physiology and acute issues of the ICU but also be focused from the very start of their care on how we are going to recover the life and quality of life the person came to us with, so we can truly create survivors, and not victims.”

Personalized approaches
A major area of focus should be the delivery of more personalized nutrition plans, that differentiate between the different phases of recovery, Wischmeyer explains.

“We need different products and different targets for our nutrition delivery and ICU care. In the first few days, we need a lower protein, lower calorie nutrient delivery formula that has thiamine, vitamin D, as well as some of the other micronutrients and trace elements that we are discovering are deficient in almost all patients.”

“In the first few days, [patients need products that provide] 0.8 to 1 gram of protein per kilo per day, and only 10 to 15 kcals,” he says. “As patients move beyond those first acute days of ICU stay, into the chronic stage, days 3 or 5 to 7, we need products that can then increase protein to 1 or 1.5 gram per kilo per day, and 25 to 30 calories per day per kilo.”

Then moving to the recovery phase, at the end of their ICU stay and when patients move back home, Wischmeyer states, “we also need key products that deliver high protein – around 2 grams per kilo per day – and higher calorie supplements, that continue to address deficiencies in vitamin D, carnitine, thiamine, copper, common in ICU patients.”

On top of that, Wischmeyer says product development should also look to nutrients such as creatine, to build muscle. 

Malnutrition as a major focus
Malnutrition among patients as well as the aging is one of the major hurdles medical nutrition needs to address. Research by Advocate Health Care and Abbott, published in July, has shown that one in three patients are malnourished or at risk of malnutrition when they're admitted to the hospital, and many are unaware of it. 

By prioritizing nutrition, care providers can significantly enhance the recovery process and deliver better value for patients and their families.

Data collected as part of Abbott’s study show that offering surgical patients nutritional care could slash hospital readmission rates by nearly 50 percent in the 30 days after being discharged and reduce the average length of hospital stay by 2.7 days. 

These findings are particularly valuable because they highlight how proper nutrition protocols can help a significant number of people recover faster from their surgeries and get back to their everyday lives, according to Suela Sulo, Ph.D., Researcher at Abbott. Moreover, they show that addressing nutrition can also help the financial health of the nation’s healthcare system. 

“The study found that reducing readmissions and shortening the length of hospital stays led to an overall cost saving of US$3,800 per patient,” she notes. “Without proper nutrition protocols, malnourished patients undergoing surgery can experience delayed wound healing, surgical site infections, a longer length of stay and higher rates of hospital readmission.”

By Lucy Gunn