Nutritional Therapy Strategies and the Risk of Refeeding Syndrome in Critically Ill Patients: An Integrative Review
DOI:
https://doi.org/10.55892/jrg.v8i19.2765Keywords:
Refeeding Syndrome, Hypophosphatemia, Nutritional Therapy, Critical PatientAbstract
The Refeeding Syndrome (RFS) is defined as a life-threatening clinical condition involving severe metabolic and electrolyte alterations, manifested after the reintroduction of calories in patients who have suffered prolonged nutritional deprivation or malnutrition. Hypophosphatemia is considered the hallmark of RFS, but the syndrome also includes hypomagnesemia, hypokalemia, thiamine deficiency, and fluid retention. The incidence of RFS shows wide variability (0% to 80%), attributed to diagnostic criteria disparities. The objective of this integrative review is to synthesize evidence regarding the influence of different nutritional therapy (NT) strategies on the risk of RFS development and clinical outcomes in critically ill patients. The integrative review methodology is a unique tool in healthcare for synthesizing investigations and guiding practice based on scientific knowledge. Findings indicate that the risk of hypophosphatemia increases significantly after NT initiation, with parenteral nutrition (PN) being more strongly associated with this risk than enteral nutrition (EN). Consensus recommendations (NICE/ASPEN) converge on advising initial caloric restriction (5 to 10 kcal/kg/day) for high-risk patients, advancing slowly to prevent complications. A relevant controversy was identified regarding initial protein supply: one study correlates high early protein intake with increased six-month mortality in patients with refeeding hypophosphatemia (RH), while another suggests that increased protein reduces the risk of RFS in COVID-19 patients. It is concluded that RFS management in critical patients demands caution, prioritizing initial caloric restriction and rigorous electrolyte monitoring, underscoring the urgency in standardizing the syndrome definition.
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