Background: Although mortality due to critical illness has fallen over decades, the number of patients with longterm\nfunctional disabilities has increased, leading to impaired quality of life and significant healthcare costs. As an\nessential part of the multimodal interventions available to improve outcome of critical illness, optimal nutrition\ntherapy should be provided during critical illness, after ICU discharge, and following hospital discharge.\nMethods: This narrative review summarizes the latest scientific insights and guidelines on ICU nutrition delivery.\nPractical guidance is given to provide optimal nutrition therapy during the three phases of the patient journey.\nResults: Based on recent literature and guidelines, gradual progression to caloric and protein targets during the\ninitial phase of ICU stay is recommended. After this phase, full caloric dose can be provided, preferably based on\nindirect calorimetry. Phosphate should be monitored to detect refeeding hypophosphatemia, and when occurring,\ncaloric restriction should be instituted. For proteins, at least 1.3 g of proteins/kg/day should be targeted after the\ninitial phase. During the chronic ICU phase, and after ICU discharge, higher protein/caloric targets should be\nprovided preferably combined with exercise. After ICU discharge, achieving protein targets is more difficult than\nreaching caloric goals, in particular after removal of the feeding tube. After hospital discharge, probably very highdose\nprotein and calorie feeding for prolonged duration is necessary to optimize the outcome. High-protein oral\nnutrition supplements are likely essential in this period. Several pharmacological options are available to combine\nwith nutrition therapy to enhance the anabolic response and stimulate muscle protein synthesis.\nConclusions: During and after ICU care, optimal nutrition therapy is essential to improve the long-term outcome to\nreduce the likelihood of the patient to becoming a â??victimâ? of critical illness. Frequently, nutrition targets are not\nachieved in any phase of recovery. Personalized nutrition therapy, while respecting different targets during the\nphases of the patient journey after critical illness, should be prescribed and monitored.
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