Nutrition For The Critically Ill

Nutrition for critically ill patients is vital, however, the optimal route of delivery and calorific targets have been controversial issues for many decades. Intensive care doctors have long wondered just how important nutrition is to the survival of the sickest hospital patients and how much food these patients need to maximise their chances of recovery. Collaborative New Zealand and Australian research — the largest intensive care nutrition trial ever undertaken — sheds light on these key questions.

A major clinical trial of 4,000 Australian and New Zealand ICU patients, led in New Zealand by the MRINZ, investigated whether a lack of nutrition could be linked to weakness, weight-loss and poorer recovery, and whether an energy-enriched formula could lead to better outcomes. The study swapped established formulas for a nutritiondense formula to determine if it would lead to better survival rates, health outcomes and faster recovery times for critically ill ICU patients.

The TARGET trial found that increasing energy delivery above the amounts provided in routine care does not increase survival at 90 days in critically ill adults, and that allowing critically ill patients to self-regulate how much food they absorb may well be a better approach to artificially trying to boost energy delivery. This finding is significant as much effort, resources and health care costs are required to increase energy delivery above routine care during the treatment of critical illness.

World-leading research from the MRINZ has contributed to a paradigm shift in the way oxygen is prescribed globally. MRINZ research showing that avoiding routine use of liberal oxygen therapy was safe and effective was a literal life-saver during the COVID-19 pandemic, providing doctors with the confidence to limit use of oxygen, thereby preserving scarce supplies in many countries, and preventing many hospitals and localities from running out of oxygen.