Prof. Mette Berger is an intensivist specialised in clinical nutrition and micronutrients. She is chairing the metabolic-endocrinology-nutrition (MEN) section of the European Society of Intensive Care Medicine (ESICM). She is member of the ESPEN-ICU guideline group. She chairs the ESPEN-micronutrient guideline group (upcoming September 2021). She has authored over 240 publications, lectures in 4 languages and continues to conduct clinical research.
The 2019 ESPEN ICU guidelines integrated research since 2000 to provide practical clinical orientation regarding the use of the different artificial nutrition strategies in teh critically ill patient. The presentation will develop the most important points. An important acquisition is the definition of the iportance of time elapsed since the start of acute illness. The patient's metabolism evolves overtime, and characteristics and needs of the first 48-72 hours differ from those of the later stabilised phase. During the acute phase the patient can rely on an important endogenous energy production: if not integrated in the calculation of the needs, early overfeeding will result. Indirect calorimetry guidance of the energy objectives improves outcome and is recommended (with repeated measures): if not available a very cautious progression to equation based goals it recommended, not exceeding 80% of those predictive targets at least during the first week. Regarding protein needs, data confirm that they are realtvely high (1.2-1.3 g/kg/day), without any clinical tool avaialble to adapt to the indivdual patients. Specific substrates such as glutamine and omega-3 PUFA belong to standards. Enteral nutrition remains the first choice when available, but the guidelines open the option for combined feeding or parenteral nutrition from day 4 on, depending ont the patient status. Micronutrient requirements are probably increaed in the early phase, and should be delivered liberally, particularly thiamine. Monitoring the patient's response to feeding to enable indivdual adaptation in emphasised.