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Introduction
19
1
measured REE
120
and during the acute phase of critical illness
117
. Therefore, application of this
parameter may be limited to the stable and recovery phase of critical illness.
In conclusion it can be stated that:
•
Low-grade and inconclusive evidence-based guidelines, resulting from a scarcity of
high-level evidence on all aspects of nutritional support in critically ill children, are
likely to allow wide variations in nutritional practices between PICUs.
•
Understanding the stress response to critical illness and the characteristics of its three
phases is essential for nutritional recommendations in critically ill children.
•
During the course of critical illness, the enteral route is preferred, but several
misconceptions concerning the provision of enteral nutrition prevent adequate
intake.
•
Use of parenteral nutrition in critically ill children is associated with potential
disadvantages, but clinical outcome studies are lacking. Parenteral nutrient restriction
early during critical illness might be beneficial for short and long-term outcomes
by amplifying the acute catabolic stress response and stimulating autophagy and
muscle integrity.
•
During the stable and recovery phase, inclining caloric and protein requirements
allow for a more aggressive feeding approach, together with mobilisation, to enable
recovery, rehabilitation and (catch-up) growth.