Potential Benefits of Medical Nutrition Therapy for Timely Ventilator Weaning in the Critically Ill.

Abstract

Nutritional support and metabolic assessment are crucial in weaning from invasive mechanical ventilation. This review explores strategies for metabolic assessment and tailored nutritional interventions and their impact on weaning outcomes, highlighting individualized nutritional interventions. While indirect calorimetry provides direct metabolic data, diaphragm ultrasound can complement metabolic monitoring by assessing respiratory muscle function and detecting early signs of muscle wasting. Protein intake in critically ill patients remains controversial, as early high protein administration (greater than 1.2 g/kg each day) has not demonstrated clear benefits and may even be detrimental to successful ventilator weaning, supporting the adoption of a moderate, individualized nutritional strategy. Vitamin D deficiency is common in critically ill patients, and targeted supplementation may reduce mechanical ventilation duration. High-fat and ketogenic diets have shown limited benefit and are not currently recommended. Some nutritional supplements (e.g., creatine, branched-chain amino acids, β-hydroxy-β-methylbutyrate) are under investigation, but current evidence does not support their routine use. A personalized approach integrating metabolic assessment, tailored protein intake, and vitamin D optimization may improve weaning success, functional recovery, and post-intensive care unit outcomes. Further research is needed to refine evidence-based guidelines.