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Fig. 2 | Critical Care

Fig. 2

From: A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

Fig. 2

Adapted from: CHUV Lausanne and Gelderse Vallei Hospitals. The X axis represents the time from admission (days, arbitrary example) and the Y axis the percentage of nutritional goal determined by a computer protocol using sex, height, weight (first 3 days) and later by indirect calorimetry or calculation prioritizing the avoidance of energy overfeeding. Regular (hourly) checks of intakes including the amount of non-nutritional energy (propofol, glucose, citrate) are recommended to adapt the infusion rate. Multi-micronutrients are administered IV until the dietary recommended intakes are met by the EN solution. The screening for refeeding syndrome is based on daily phosphate determination from day 2. In case of hypophosphatemia (hypoP) (serum phosphate (PO4) < 0.65 mmol/l, or a drop from baseline > 0.16 mmol/l occurring within 72 h of the start of EN) decrease the amount of energy delivered to a maximum of 500 kcal/day, supplement phosphate, magnesium (Mg) and potassium (K) and additional boluses of thiamine (vit B1, 500–1000 mg IV)

Recommendations for the progression of enteral nutrition delivery, micronutrients delivery and management of refeeding.

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