Hypocaloric feeding in critically ill trauma patients: A scoping review of the literature.

Abstract

Abstract: Following traumatic injury, a state of hypercatabolism ensues because of the burden of critical illness, stress, tissue injury, wound healing, drug administration, and inflammation, making optimal nutritional support imperative. Hypocaloric feeding, which entails prioritizing protein delivery over caloric supply early on in critical illness, has garnered substantial attention in critical care nutrition. Hypocaloric feeding has been examined closely in medical intensive care units (ICUs) but has been understudied in surgical ICUs, much less in the traumatically injured patient. This scoping review aims to provide a landscape of the available literature on hypocaloric feeding in critically ill trauma patients and establish where major knowledge gaps and questions remain. Primary literature on the effects of caloric and protein intake in trauma patients was systematically identified using PubMed. Literature was further filtered to only include studies that included or focused entirely on trauma patients and the effects of caloric or protein manipulation and provision. Data on sample sizes, nutritional regimens, conclusions, and confounders were charted for studies that met eligibility criteria. Twenty-six total studies were eligible for inclusion. Among these, 50% were retrospective cohort studies, 35% were randomized controlled trials (RCTs), 11% were prospective cohort studies, and 4% were historically controlled trials. When viewed as a whole, the effect of hypocaloric nutrition on critically ill trauma patients appeared variable and often contradictory. However, when the available RCTs that were performed in trauma populations or included a substantial number of trauma patients were examined in isolation, hypocaloric feeding was either beneficial or neutral in its effect on ICU outcomes. Hypocaloric nutrition is safe and feasible in critically ill trauma patients. However, large RCTs dedicated specifically to trauma populations are warranted to determine if hypocaloric feeding improves overall outcomes in this unique patient population.LEVEL OF EVIDENCE:Literature Review; Level III.