title: How Many Nonprotein Calories Does a Critically Ill Patient Require? A Case for Hypocaloric Nutrition in the Critically Ill Patient.
abstract: Calculation of energy and protein doses for critically ill patients is still a matter of controversy. For more than 40 years of nutrition support, the total amount of nutrients to be delivered to these patients has been calculated based on expert recommendations, and this calculation is based on the administration of nonprotein calories in one attempt to ameliorate catabolic response and avoid the weight loss. New evidence suggests protein delivery is the most important intervention to improve clinical and metabolic outcomes. This article describes the metabolic rationale and the new evidence supporting a change in the approach of metabolic support of the critically ill, proposing a physiological-based intervention supported by the recognition of ancillary characteristics of the metabolic response to trauma and injury. A moderate dose of calories around 15 kcal/kg/d with a delivery of protein of 1.5 g/kg/d appears to be the new recommendation for many hypercatabolic patients in the first week following injury.
authors.affiliation: 1 Pontificia Universidad Javeriana School of Medicine, Hospital Universitario San Ignacio, Bogota, Colombia.
authors.forename: Saúl J
authors.initials: SJ
authors.lastname: Rugeles
authors.affiliation: 2 Nestlé Health Science Institute, Lausanne, Switzerland.
authors.forename: Juan B
authors.initials: JB
authors.lastname: Ochoa Gautier
authors.affiliation: 3 University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Roland N
authors.initials: RN
authors.lastname: Dickerson
authors.affiliation: 4 Director of Research, Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Intensive Care Service, Texas Children's Hospital, Houston Texas, USA.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Coss-Bu
authors.affiliation: 5 Department of Clinical Science Interventional Technology, Karolinska Universitetssjukhuset, Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Wernerman
authors.affiliation: 6 Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, Texas, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Paddon-Jones
mesh_terms: D016638:Critical Illness; D002149:Energy Intake; D006801:Humans; D009751:Nutritional Requirements; D018529:Nutritional Support; D010288:Parenteral Nutrition / Q000592:standards*
keywords: critical illness; enteral nutrition; hypocaloric nutrition; intensive care unit; nutritional support; protein