The energy requirement after ICU discharge and strategies to improve nutritional adequacy

Abstract

The transition from intensive care unit (ICU) to general wards marks a critical juncture in the recovery of critically ill patients, characterized by persistently high metabolic demands and vulnerability to malnutrition. Despite growing awareness of the importance of nutrition during this phase, there is a significant evidence gap regarding specific energy and protein requirements post-ICU discharge. This review explores the current recommendations and literature on energy and protein provision in ICU survivors, highlighting the complexity of post-ICU nutritional needs driven by hypermetabolism, physical rehabilitation, and the presence of anabolic resistance in older and frail patients. The inadequacy of nutritional intake in post-ICU settings is consistently reported, particularly among patients relying solely on oral nutrition. Barriers such as appetite dysregulation, dysphagia, post-intensive care syndrome, and systemic issues including rigid food service structures further compromise recovery. Innovative strategies, including the use of indirect calorimetry, targeted supplementation, and personalized nutritional interventions, are essential to bridge this “nutritional gap.” This review underscores the need for structured post-ICU nutritional care pathways, interdisciplinary coordination, and continued research to define evidence-based targets for energy and protein intake during convalescence.