TSS-strategy for starting nutritional support in critically ill patients

Abstract

Protein energy malnutrition in critically ill patients affects their condition to a large extent, increasing the probability of infections and death. It significantly prolongs their stay in the intensive care unit (ICU). Nutritional support in ICU is central in the treatment. Nutritional and metabolic support is regulated by care standards in anesthesiology and critical and emergency care. Therefore, updating and systematizing the knowledge on nutritional support in ICU is key to improving the care quality.

In this scientific review, we analyzed relevant domestic and foreign publications on malnutrition. Then a TSS-strategy (timely, stepwise, and specific) was devised for the start of nutritional support with enteral nutrition in critically ill patients. The strategy was based on 2023 guideline by European Society for Clinical Nutrition and Metabolism (ESPEN).

“Timely” means early start of nutritional support in critically ill patients. “Stepwise” suggests that an algorithm for adding protein and energy in increments be followed to prevent overfeeding the patient during the first 24 hours in ICU. “Specific” refers to the use of high-nitrogen formulas with moderate caloric content that were developed specifically for critically ill patients.

We hereby suggest a strategy for nutritional support start that is fully in line with current clinical guidelines and allows achieving better outcomes when treating critically ill patients.

Keywords

Protein energy malnutrition / nutritional support / critical conditions / ICU

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