Management of Enteral Nutrition in Critically Ill Geriatric Patients
Abstract
Introduction: Elderly patients admitted to the intensive care unit (ICU) exhibit distinct physiological, immunological, and metabolic vulnerabilities that necessitate a tailored nutritional approach. Enteral nutrition (EN) is the preferred strategy over parenteral nutrition due to its physiological benefits, but its implementation in critically ill geriatric patients is met with multiple challenges, including sarcopenia and anabolic resistance.
Methods: This study is a narrative literature review based on scientific journals, textbooks, and recent clinical guidelines. It aims to provide a comprehensive overview of the principles of enteral nutrition in critically ill geriatric patients, covering physiological differences, selection of routes and formulas, and determination of nutritional requirements.
Results: Older adults experience significant metabolic alterations, such as anabolic resistance, pre-existing sarcopenia, and gut dysbiosis, which influence their nutritional needs and response to EN. Evidence shows that early EN initiation (within 24-48 hours of ICU admission) improves clinical outcomes, including reduced infection rates and length of stay, but must be individualized. Energy-dense, high-protein formulas are generally recommended to counteract muscle loss, with a protein target of 1.2-1.5 g/kg/day. Close monitoring for complications such as refeeding syndrome, aspiration, and gastrointestinal intolerance is critical. The selection of the feeding route (gastric vs. jejunal) should be guided by the patient's clinical status and aspiration risk.
Conclusions: Enteral nutrition strategies in critically ill geriatric patients must be individualized, evidence-based, and account for age-related physiological changes to optimize functional recovery and improve clinical outcomes. A careful, stepwise approach is essential to maximize benefits while minimizing risks in this vulnerable population.
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Jawa RS, Patel RB, Young DH. Nutritional Assessment. Crit Care Clin. 2021;37(1):205-19.
Berlana D. Parenteral Nutrition Overview. Nutrients. 2022;14(21):4480.
Lee ZY, Loh CTI, Lew CCH, Ke L, Heyland DK, Hasan MS. Nutrition therapy in the older critically ill patients: A scoping review. Ann Acad Med Singap. 2022;51(10):629-36.
Darden DB, Moore FA, Brakenridge SC, Navarro EB, Anton SD, Leeuwenburgh C, et al. The Effect of Aging Physiology on Critical Care. Crit Care Clin. 2021;37(1):135-50.
Heffernan AJ, Talekar C, Henain M, Purcell L, Palmer M, White H. Comparison of continuous versus intermittent enteral feeding in critically ill patients: a systematic review and meta-analysis. Crit Care. 2022;26(1):308.
Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr. 2023;42(9):1671-89.
Wischmeyer PE, Bear DE, Berger MM, De Waele E, Gunst J, McClave SA, et al. Personalized nutrition therapy in critical care: 10 expert recommendations. Crit Care. 2023;27(1):271.
Akinosoglou K, Schinas G, Almyroudi MP, Gogos C, Dimopoulos G. The impact of age on intensive care. Ageing Res Rev. 2023;84:101832.
Domenech-Briz V, Gea-Caballero V, Czapla M, Chover-Sierra E, Juárez-Vela R, Santolalla Arnedo I, et al. Importance of nutritional assessment tools in the critically ill patient: A systematic review. Front Nutr. 2023;9:1073782.
Hill A, Elke G, Weimann A. Nutrition in the Intensive Care Unit-A Narrative Review. Nutrients. 2021;13(8):2851.
McKendry J, Thomas ACQ, Phillips SM. Muscle Mass Loss in the Older Critically Ill Population: Potential Therapeutic Strategies. Nutr Clin Pract. 2020;35(4):607-16.
Wissanji T, Forget MF, Muscedere J, Beaudin D, Coveney R, Wang HT. Models of Care in Geriatric Intensive Care A Scoping Review on the Optimal Structure of Care for Critically Ill Older Adults Admitted in an ICU. Crit Care Explor. 2022;4(4):e0661.
Brunker LB, Boncyk CS, Rengel KF, Hughes CG. Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges. Clin Interv Aging. 2023;18:93-112.
De Biasio JC, Mittel AM, Mueller AL, Ferrante LE, Kim DH, Shaefi S. Frailty in Critical Care Medicine: A Review. Anesth Analg. 2020;130(6):1462-73.
Firth J, Conlon C, Cox T, editors. Oxford Textbook of Medicine. 6th ed. Oxford: Oxford University Press; 2020.
Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's Principles of Internal Medicine. 21st ed. New York: McGraw-Hill Education; 2022.
Feather A, Randall D, Waterhouse R, editors. Kumar and Clark's Clinical Medicine. 10th ed. London: Elsevier; 2020.
Nishioka S, Nakahara S, Takasaki M, Shiohama N, Kokura Y, Suzuki T, et al. The concept of aggressive nutrition therapy and clinical indication: A position paper. Clin Nutr ESPEN. 2022;52:322-30.
Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. J Parenter Enteral Nutr. 2022;46(1):12-41.
Doley J. Enteral Nutrition Overview. Nutrients. 2022;14(11):2180.
Hill A, Heyland DK, Ortiz Reyes LA, Laaf E, Wendt S, Elke G, et al. Combination of enteral and parenteral nutrition in the acute phase of critical illness: An updated systematic review and meta-analysis. J Parenter Enteral Nutr. 2022;46(2):395-410.
Alsharif DJ, Alsharif FJ, Aljuraiban GS, Abulmeaty MMA. Effect of Supplemental Parenteral Nutrition Versus Enteral Nutrition Alone on Clinical Outcomes in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2020;12(10):2968.
Goldman L, Schafer Al, editors. Goldman-Cecil Medicine. 26th ed. Philadelphia: Elsevier; 2020.
Chauhan D, Varma S, Dani M, Fertleman MB, Koizia LJ. Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced. Curr Gerontol Geriatr Res. 2021;2021:1-7.
Liebau F, Deane AM, Rooyackers O. Protein absorption and kinetics in critical illness. Curr Opin Clin Nutr Metab Care. 2021;24(1):71-8.
Hoffmann M, Schwarz CM, Fürst S, Starchl C, Lobmeyr E, Sendlhofer G, et al. Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis. Nutrients. 2020;13(1):82.
Jordan EA, Moore SC. Enteral nutrition in critically ill adults: Literature review of protocols. Nurs Crit Care. 2020;25(1):24-30.
Penman ID, Ralston SH, Strachan MWJ, Hobson R, editors. Davidson's Principles and Practice of Medicine. 24th ed. London: Elsevier; 2022.
De Sire A, Ferrillo M, Lippi L, Agostini F, De Sire R, Ferrara PE, et al. Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review. Nutrients. 2022;14(5):982.
Belzarez Guedez JB, Helena Lenardt M, Cechinel C, Martins Rodrigues JA, Da Silva Marques DM, Angelica Binotto M. Elderly Feeding and Nutrition during Hospitalization: An Integrative Review. Open J Nurs. 2023;13(11):735-53.
Tatucu-Babet O, Lambell K, Ridley EJ. Nutritional Management of the Critically Ill Older Adult. ICU Manag Pract. 2020;20(3):185-90.
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