[Specialized Nutrition Formulations for Intensive Care Patients: Tool or Toy?]

Abstract

The market offers a wide range of medical nutrition formulations for oral, enteral and parenteral nutrition of critically ill patients. In addition to so-called "standard" nutrition formulations, which are available in different variants and already cover a wide range of products, there are also specialized nutrition formulations that have been developed specifically for certain diseases.According to current evidence, normocaloric "standard" nutrition formulations are the first choice. However, in certain cases, depending on the clinical picture, phase of illness and individual tolerance, energy-dense or protein-rich variants as well as fiber-containing or fiber-free options may also be useful. These products enable individualized disease- and phase-specific nutrition therapy in clinical practice.However, the evidence for the benefits of specialized nutrition formulations that are tailored to specific metabolic changes and particular needs of individual clinical pictures is currently limited. Such specialized products should therefore only be used in individual cases and under consideration of medical and therapeutic conditions: Special nutrition formulations for patients with diabetes mellitus and kidney disease can simplify metabolic control and the practice of nutritional therapy. By carrying out close metabolic monitoring, special nutrition formulations can be used individually in these patients. However, specialized nutrition formulations for patients with liver or lung disease are not recommended based on current evidence and guidelines.While the evidence for the use of special substrates in pharmacological doses is still limited, they are an integral part of clinical nutrition products in physiological doses.Particular attention should be paid to complete protein/amino acid patterns (dispensable, indispensable and conditionally indispensable amino acids) and mixed lipid emulsions (soy, olive, fish oil, medium-chain triglycerides) in parenteral nutrition products.