INTRODUCTION: There is a lack of guidelines or formal systematic synthesis of evidence for nutrition therapy in older critically ill patients. This study is a scoping review to explore the state of evidence in this population. METHOD: MEDLINE and Embase were searched from inception until 9 February 2022 for studies that enrolled critically ill patients aged ≥60 years and investigated any area of nutrition therapy. No language or study design restrictions were applied. RESULTS: Thirty-two studies (5 randomised controlled trials) with 6 topics were identified: (1) nutrition screening and assessments, (2) muscle mass assessment, (3) route or timing of nutrition therapy, (4) determination of energy and protein requirements, (5) energy and protein intake, and (6) pharmaconutrition. Topics (1), (3) and (6) had similar findings among general adult intensive care unit (ICU) patients. Skeletal muscle mass at ICU admission was significantly lower in older versus young patients. Among older ICU patients, low muscularity at ICU admission increased the risk of adverse outcomes. Predicted energy requirements using weight-based equations significantly deviated from indirect calorimetry measurements in older vs younger patients. Older ICU patients required higher protein intake (>1.5g/kg/day) than younger patients to achieve nitrogen balance. However, at similar protein intake, older patients had a higher risk of azotaemia. CONCLUSION Based on limited evidence, assessment of muscle mass, indirect calorimetry and careful monitoring of urea level may be important to guide nutrition therapy in older ICU patients. Other nutrition recommendations for general ICU patients may be used for older patients with sound clinical discretion.
Adult ; Humans ; Aged ; Critical Illness/therapy* ; Enteral Nutrition ; Nutritional Support ; Nutritional Requirements ; Intensive Care Units ; Energy Intake

Introduction: This study aimed to compare the nutritional characteristics and clinical outcomes among critically ill patients with diabetes (DM) and without diabetes (WDM). Methods: Mechanically ventilated, critically ill patients who were admitted into the intensive care unit (ICU) within 48 hours and remained in ICU ≥72 hours were prospectively recruited and followed for up to 12 days. They were stratified to DM or WDM, depending on their diabetes status at ICU admission and comparison were made for nutritional characteristics and clinical outcomes including 60-day mortality. Results: A total of 154 patients were included with 73 (47.4%) DM patients. In comparison to WDM, patients with DM were older, more severely ill, had higher nutritional risk and body mass index, presented with a higher blood glucose level, and required more insulin. DM was fed relatively earlier but had lower energy adequacy. They experienced more frequent EN interruption. Both groups had comparable ICU and hospital stay, ventilation support duration and mortality. In multivariable logistic regression, no association was found between diabetes status and for ICU and hospital mortality. However, There was a trend towards an increase in 60-day mortality in DM patients (Odds Ratio: 2.220, 95% Confidence Interval: 0.764-6.452; p=0.143). Conclusion: Critically ill patients with DM had higher nutritional risks, were fed relatively earlier, but with frequent EN interruption leading to lower energy adequacy than patients WDM. Diabetes status does not affect clinical outcomes.

Introduction: The limited data regarding nutrition characteristics and the delivery of critically ill patients in South Asia is intriguing. This study was conducted to investigate the nutrition characteristics and delivery in relation to 28- day mortality in mechanically ventilated patients. Methods: This prospective observational study was conducted in the intensive care unit (ICU) of the Maldives government referral hospital. Data about nutrition characteristics and delivery were collected from the ICU charts, and each patient was followed for a maximum of 28 days. Results: We recruited a total of 115 patients (mean age: 61.57±17.26 years, 52% females, mean BMI: 25.5±6.19kg/m2), of which 61 (53%) of them died within 28 days of ICU admission. Mean energy intake was 681.15±395.37 kcal per day, and mean protein intake was 30.32±18.97g per day. In the univariate logistic regression analysis, length of stay in ICU (OR = 0.950, 95% CI: 0.908 – 0.994, p = 0.027), and received intervention by a dietitian (OR = 0.250, 95% CI: 0.066 – 0.940, p = 0.040) were associated with 28-day mortality. None of the factors in the multivariate regression analysis remains significant when adjusted for sex, SOFA total score, daily energy and protein dosage. Conclusion: 28-day mortality was much higher in this study than in similar studies in South Asia, Asia and around the globe. None of the variables was significantly associated with 28-day mortality in the multivariate logistic model. However, there was a trend towards higher mortality for patients with shorter length of stay in the ICU, larger mean gastric residual volume, and no intervention by a dietitian.