Toward Precision in Nutrition Therapy

Critical Care Medicine, vol. 53, pp. e429–e440

Abstract

Precision in critical care nutrition is paramount, as it focuses nutrition interventions on those patients most likely to benefit, or those who might potentially be harmed. Critical care nutrition must therefore be tailored to individual metabolic needs as determined by factors that control the capacity for tissue homeostasis and anabolic responses. This ideally involves the accurate and timely assessment of macronutrient and micronutrient requirements, a careful evaluation of metabolic response mechanisms and the identification of circumstances that might interfere with the productive utilization of dietary substrates. Specific surrogate markers of metabolic response, such as blood glucose levels, urea levels, or nitrogen balance, might be used to evaluate the metabolic readiness for nutrition and to establish the timing, nature, and clinical effectiveness of nutrition interventions. Despite the pressing need to further develop more targeted approaches in critically ill patients, indices of immediate metabolic responses that correlate with favorable clinical outcomes are lacking. In addition, the development of precision approaches might address timely adjustments in protein, energy, or micronutrient supplementation based on evolving clinical conditions. Here, we review why precision tools are needed in critical care nutrition, our progress thus far, as well as promising approaches and technologies by which multidisciplinary healthcare teams can improve quality of care and clinical outcomes by individualizing nutrition interventions.

Authors 4

1. Christian Stoppe

   University of Würzburg · Universitätsklinikum Würzburg · Stiftung Charité · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany

   Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany

2. Aileen Hill Aachen Department of Anesthesiology Department of Operative Intensive Care Medicine

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Anesthesiology and Department of Operative Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany

3. Kenneth B. Christopher

   Brigham and Women's Hospital

   Affiliation as printed

   Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA

   Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA

   Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA

   Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA

4. Arnold S. Kristof

   Research Institute of the McGill University Health Centre · McGill University

   Affiliation as printed

   Departments of Critical Care and Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada

   Meakins-Christie Laboratories and Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canda