J Neurointensive Care.
2023 Oct;6(2):84-97. 10.32587/jnic.2023.00689.
Neurocritical Care Nutrition: Unique Considerations and Strategies for Optimizing Energy Supply and Metabolic Support in Critically Ill Patients
- Affiliations
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- 1Department of Neurological Surgery and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 2Department of Neurological Surgery and Critical Care Medicine, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, Korea
- 3Department of Neurological Surgery and Critical Care Medicine, Chungnam National University Hospital, Daejeon, Korea
- 4Department of Neurological Surgery and Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
- 5Department of Neurological Surgery and Critical Care Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- 6Department of Neurological Surgery and Critical Care Medicine, Kangbuk Samsung Hospital, Seoul, Korea
- 7Department of Neurological Surgery and Critical Care Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- 8Department of Neurological Surgery and Critical Care Medicine, Yeungnam University Medical Center, Daegu, Korea
- 9Department of Neurological Surgery and Critical Care Medicine, Gachon University Gil Hospital Regional Trauma Center, Incheon, Korea
- 10Department of Neurological Surgery and Critical Care Medicine, Gangnam Severance Hospital, Seoul, Korea
- 11Department of Neurological Surgery and Critical Care Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Korea
- KMID: 2555087
- DOI: http://doi.org/10.32587/jnic.2023.00689
Abstract
- Neuro-critically ill patients face unique challenges in nutritional support due to varying metabolic and energy demands arising from clinical situations such as elevated intracranial pressure, trauma, stroke, epilepsy, targeted temperature management (TTM), and pharmacological interventions. Despite these challenges, there is a lack of systematic reviews addressing their specific needs. This study conducts a systematic review and narrative synthesis of the existing literature on nutritional support for neuro-critical patients, focusing on amino acids that act as neurotransmitters or their precursors. We examined nutritional requirements and timing in patients with stroke and traumatic brain injury, as well as energy and metabolic demands during TTM, a common therapeutic intervention in neuro-critical care. Our review aims to clarify uncertainties surrounding amino acid provision in neuro-critical patients and provide up-to-date recommendations on nutritional support for those with elevated intracranial pressure and undergoing TTM, serving as a foundation for future research and evidence-based guideline development. Key findings include the potential benefits of branched-chain amino acids (BCAAs) in neuro-critical care, the roles of methionine and serine, the significance of arginine in vascular constriction, the controversial role of glutamate in nutrition, and the potential benefits of selenium supplementation. We also discussed special considerations in nutritional support for neuro-critical patients, such as changes in energy demand, the influence of sedation on energy demand, and metabolism changes during TTM. Our review highlights the need for a better understanding of the unique metabolic requirements of neuro-critical patients and the development of evidence-based guidelines for optimal nutritional support in this population.
