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Obese ICU patients are more likely than lean subjects to have problems of greater loss of lean body mass. They are also at the highest risk because of the presence of metabolic syndrome which increased ICU complication and mortality.
A woman, 53, an internist. She felt weakness on the left body suddenly before admitted to ICU.
Weight 95 kg, Height 145 cm, BMI 45.1 kg/m2. Ideal Body Weight (IBW) was 45 kg. She oftentimes consumes fried meals and snacks in a big portion. At day 1 in ICU, patient consumed enteral feeding 80ml/hour in 7 hours intermittently (energy 560kcal; protein 22gram).
“The increased protein needs related to metabolic response to injury and to preserve lean body mass as evidenced by BMI 45.1 kg/m2 and hypertriglyceridemia on hemorrhagic stroke”.
Nutrition intervention was to minimize loss of lean body mass using high-protein hypocaloric diet.The final nutrient prescription was enteral 80ml/hour. The energy needs used 25-30kcal/IBW (1125kcal–1350kcal) as local hospital protocol. The mean of energy intake in 11 days of care was 1.271,1 kcal (28kcal/IBW) and protein 62.4 gram (1.39 gram/IBW/day). The range of energy was 560kcal–1680kcal, protein was 0.5 gram/IBW/day – 1.7 gram/IBW/day.
There was no hyperglycemia period during ICU care, but she had high triglyceride level (197 mg/dL). Albumin level decreased during care. Ureum level increased day by day, while creatinine was still in normal levels as parameters for kidney dysfunction.
In a retrospective study of 40 obese critically ill surgical and trauma patients, use of high-protein hypocaloric EN was associated with shorter ICU stay, decreased duration of antibiotics, and fewer days of mechanical ventilation compared with use of a high-protein eucaloric diet.
High-protein hypocaloric feeding is suggested to be implemented in the care of obese ICU patients to preserve lean body mass, mobilize adipose stores, and minimize the metabolic complications of overfeeding. It is a big challenge to provide high protein diet formula for obese patient through enteral feeding because most enteral formulas have a high NPC:N. Follow-up nutrition care of the obese ICU patient focus on biomarkers of metabolic syndrome and organ dysfunction due to high-protein hypocaloric diet.