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Nutritional Support for Critically Ill Patients

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: 5 July 2026 | Viewed by 3644

Special Issue Editors


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Guest Editor
Department of Clinical Nutrition, Evangelismos General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece
Interests: diet; nutrition; reproduction; clinical nutrition; obesity; enteral nutrition; critical care; nutritional assessment
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Guest Editor
Intensive Care Medicine, Center for Respiratory Failure, General Ηospital of Thoracic Diseases, Sotiria, 11527 Athens, Greece
Interests: metabolism; nutrition; critical care nutrition; pulmonary disease; COVID-19
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the high-stakes environment of the intensive care unit (ICU), nutrition often remains an underappreciated component of patient care. Yet, it is increasingly recognized that timely and individualized nutritional support is not merely supportive but therapeutic, influencing outcomes such as infection rates, length of stay, and mortality.

The recent literature has highlighted several critical challenges in ICU nutrition. A notable article, “Nutrition therapy for critically ill patients—Five key problems”, identifies persistent issues, including the immunologic background of catabolism, determining energy goals during the acute phase, quantifying endogenous energy production, assessing protein requirements, and the need for individualized nutrition therapy. These challenges underscore the complexity of providing effective nutritional support in critical care settings.

This Special Issue of Nutrients, titled “Nutritional Support for Critically Ill Patients”, seeks to address these challenges by bringing together research and clinical insights that can inform and improve nutritional practices in the ICU. We invite contributions that explore the following:

  • Immunologic aspects of catabolism: understanding how critical illness induces catabolic states and how nutrition can modulate immune responses.
  • Energy requirements during acute phases: investigating methods to accurately determine energy needs, considering endogenous energy production.
  • Protein metabolism and requirements: evaluating optimal protein dosing strategies to mitigate muscle wasting and support recovery.
  • Individualized nutrition therapy: developing approaches that tailor nutritional support to individual patient needs, considering factors such as disease state, metabolic response, and recovery trajectory.

Moreover, the integration of digital tools in nutritional assessment and monitoring presents new opportunities. For instance, smartphone-based applications have shown promise in facilitating nutritional risk screening and dietary assessments among hospitalized patients. Such technologies could enhance the precision and efficiency of nutritional interventions in critical care.

We also encourage submissions that examine the following:

  • Micronutrient supplementation: the role of vitamins and trace elements in supporting immune function and recovery.
  • Enteral and parenteral nutrition strategies: optimizing delivery methods to meet patient needs effectively.
  • Long-term outcomes: assessing how nutritional interventions impact recovery beyond the ICU, including functional status and quality of life.

This Special Issue aims to serve as a comprehensive resource for clinicians, dietitians, researchers, and all healthcare professionals involved in the care of critically ill patients. By addressing the identified challenges and exploring innovative solutions, we hope to advance the field of critical care nutrition and improve patient outcomes.

We look forward to your contributions that will enrich this discussion and drive progress in nutritional support for critically ill patients.

Dr. Dimitrios T. Karayiannis
Dr. Zafeiria Mastora
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • critical care nutrition
  • metabolic response
  • protein requirements
  • enteral nutrition
  • parenteral nutrition
  • individualized nutrition therapy
  • catabolism in critical illness
  • micronutrient supplementation

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Published Papers (4 papers)

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Research

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14 pages, 671 KB  
Article
Nutrition Support Adequacy in Children with Biliary Atresia After Liver Transplant
by Nicole Knebusch, Manpreet Virk, Moreshwar S. Desai, Marwa Mansour, Stacey Beer, Brittany Pearo, Kelby Fuller, Krupa Mysore, John Goss, Thomas Fogarty, Fernando Stein and Jorge A. Coss-Bu
Nutrients 2026, 18(1), 133; https://doi.org/10.3390/nu18010133 - 31 Dec 2025
Viewed by 332
Abstract
Background: The nutrition support of children with biliary atresia after liver transplant is affected by multiple factors, and a connection between these factors and conditions present before transplant can potentially make the nutrition support more challenging. We aim to assess the adequacy of [...] Read more.
Background: The nutrition support of children with biliary atresia after liver transplant is affected by multiple factors, and a connection between these factors and conditions present before transplant can potentially make the nutrition support more challenging. We aim to assess the adequacy of nutrition support, specifically energy and protein, during the first week of admission to the Pediatric Intensive Care Unit (PICU) in children after liver transplant secondary to biliary atresia. Methods: We performed a retrospective cohort study of 138 patients [13.9 median (9–33.4) IQR months; 62% female] with a diagnosis of biliary atresia admitted to the PICU after liver transplantation at Texas Children’s Hospital over a 14-year study period. We obtained nutrition adequacy of enteral and parenteral nutrition support for the first week after transplant during their PICU admission. Results: Goal adequacy was reached at the end of the first week of admission when combined enteral and parenteral nutrition support was provided (median 98% for energy and 101% for protein). Infants achieved significantly higher adequacies than older children during the first week (136% < 1 year vs. 0% > 1 year, p < 0.001 for calories, and 157% < 1 year vs. 0% > 1 year for protein; p < 0.01). Conclusions: These findings highlight the complex nutritional challenges faced by this population, and strategies are needed to meet the unique needs of children after liver transplantation. Full article
(This article belongs to the Special Issue Nutritional Support for Critically Ill Patients)
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14 pages, 493 KB  
Article
Nutritional Support Patterns and Outcomes in Pediatric Veno-Venous and Veno-Arterial Extracorporeal Membrane Oxygenation: A Retrospective Analysis
by Marwa Mansour, Nancy Chung, Blessy Philip, Kelly Martinek, Jesse Stoakes, Sarah Nelin, Nicole Knebusch, Cole Burgman, Jorge A. Coss-Bu and Andrea Ontaneda
Nutrients 2025, 17(24), 3928; https://doi.org/10.3390/nu17243928 - 16 Dec 2025
Viewed by 496
Abstract
Background: Nutritional support in patients receiving extracorporeal membrane oxygenation (ECMO) is a clinical challenge. Hemodynamic instability and concerns about gut perfusion delay enteral nutrition (EN), resulting in frequent use of total parenteral nutrition (TPN). This study aimed to compare nutritional practices in patients [...] Read more.
Background: Nutritional support in patients receiving extracorporeal membrane oxygenation (ECMO) is a clinical challenge. Hemodynamic instability and concerns about gut perfusion delay enteral nutrition (EN), resulting in frequent use of total parenteral nutrition (TPN). This study aimed to compare nutritional practices in patients on venoarterial (VA) vs. venovenous (VV) ECMO, and to evaluate the associations between prolonged TPN use, feeding status, circuit change frequency, length of stay, and survival. Methods: Retrospective cohort study of ECMO patients in a quaternary pediatric intensive care unit. Nutritional variables included route and amount of nutrition delivery. The primary outcome was the nutrition type (enteral vs. parenteral) in association with ECMO mode (VV vs. VA). Secondary outcomes included associations between nutrition variables (TPN by Day 14, lack of EN by Day 5 or 7) and circuit changes, ECMO duration, ICU/hospital length of stay (LOS), and mortality. Analyses by Mann–Whitney and chi-square tests. Multivariable Poisson regression was used to identify independent predictors of circuit change frequency. Results: Patients on VV ECMO achieved higher enteral intake than those on VA ECMO. Persistent need for TPN by Day 14 was associated with longer PICU LOS, hospital LOS, and ECMO duration and was independently associated with 71% higher circuit change frequency. Survival did not differ significantly by TPN duration or early EN exposure. Conclusions: VV ECMO patients received higher enteral nutrition. Persistent need for TPN by day 14 was associated with worse outcomes. These findings underscore the need for standardized, evidence-based feeding strategies in this population. Full article
(This article belongs to the Special Issue Nutritional Support for Critically Ill Patients)
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12 pages, 842 KB  
Article
Integrating Nutrition, Inflammation, and Immunity: The CALLY Index as a Novel Prognostic Biomarker in Acute Geriatric Care
by Francesca Mancinetti, Anna Giulia Guazzarini, Martina Gaspari, Michele Francesco Croce, Rocco Serra, Patrizia Mecocci and Virginia Boccardi
Nutrients 2025, 17(20), 3192; https://doi.org/10.3390/nu17203192 - 10 Oct 2025
Viewed by 1271
Abstract
Background/Objectives: Malnutrition, systemic inflammation, and immune dysfunction are key determinants of adverse outcomes in older adults following acute illness. Composite biomarkers integrating these domains could enhance early risk stratification. This study investigates, for the first time in acute geriatric care, the prognostic value [...] Read more.
Background/Objectives: Malnutrition, systemic inflammation, and immune dysfunction are key determinants of adverse outcomes in older adults following acute illness. Composite biomarkers integrating these domains could enhance early risk stratification. This study investigates, for the first time in acute geriatric care, the prognostic value of the C-reactive protein–albumin–lymphocyte (CALLY) index—a composite marker of nutritional, inflammatory, and immune status—in predicting short-term survival. Methods: We retrospectively analyzed 264 patients admitted to the acute geriatrics ward of Santa Maria della Misericordia Hospital in Perugia. The CALLY index was calculated as: (Albumin × Lymphocytes)/(CRP × 104). The optimal prognostic cut-off was determined using receiver operating characteristic (ROC) curve analysis. Three-month survival was assessed by Kaplan–Meier analysis. Results: The cohort included 167 women (63.3%) and 97 men (36.7%), with a mean age of 88.0 ± 6.4 years. At 3-month follow-up, 80 patients (30.3%) had died. The CALLY index showed an area under the ROC curve of 0.647 (95% CI: 0.576–0.718; p < 0.001), with a cut-off of 0.055 (sensitivity: 68.5%, specificity: 46.3%). Among deceased patients, 42.5% had a CALLY index <0.055. After multivariable adjustment, a lower CALLY index remained independently associated with increased mortality (B = −0.805; OR = 0.45; 95% CI: 0.215–0.930; p = 0.031). Kaplan–Meier analysis demonstrated significantly higher survival in patients with a CALLY index ≥ 0.055 (Log-rank test: 13.71; p < 0.001). Conclusions: The CALLY index shows a modest but statistically significant discriminative ability for predicting short-term mortality in acutely ill older adults. As a simple, low-cost marker derived from routine laboratory tests, it holds potential for integration into clinical workflows to guide nutritional, metabolic, and prognostic management strategies in geriatric acute care. Full article
(This article belongs to the Special Issue Nutritional Support for Critically Ill Patients)
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Review

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22 pages, 1143 KB  
Review
AI-Enabled Precision Nutrition in the ICU: A Narrative Review and Implementation Roadmap
by George Briassoulis and Efrossini Briassouli
Nutrients 2026, 18(1), 110; https://doi.org/10.3390/nu18010110 - 28 Dec 2025
Viewed by 739
Abstract
Background: Artificial intelligence (AI) is increasingly used in intensive care units (ICUs) to enable personalized care, real-time analytics, and decision support. Nutritional therapy—a major determinant of ICU outcomes—often remains delayed or non-individualized. Objective: This study aimed to review current and emerging AI applications [...] Read more.
Background: Artificial intelligence (AI) is increasingly used in intensive care units (ICUs) to enable personalized care, real-time analytics, and decision support. Nutritional therapy—a major determinant of ICU outcomes—often remains delayed or non-individualized. Objective: This study aimed to review current and emerging AI applications in ICU nutrition, highlighting clinical potential, implementation barriers, and ethical considerations. Methods: A narrative review of English-language literature (January 2018–November 2025) searched in PubMed/MEDLINE, Scopus, and Web of Science, complemented by a pragmatic Google Scholar sweep and backward/forward citation tracking, was conducted. We focused on machine learning (ML), deep learning (DL), natural language processing (NLP), and reinforcement learning (RL) applications for energy/protein estimation, feeding tolerance prediction, complication prevention, and adaptive decision support in critical-care nutrition. Results: AI models can estimate energy/protein needs, optimize EN/PN initiation and composition, predict gastrointestinal (GI) intolerance and metabolic complications, and adapt therapy in real time. Reinforcement learning (RL) and multi-omics integration enable precision nutrition by leveraging longitudinal physiology and biomarker trajectories. Key barriers are data quality/standardization, interoperability, model interpretability, staff training, and governance (privacy, fairness, accountability). Conclusions: With high-quality data, robust oversight, and clinician education, AI can complement human expertise to deliver safer, more targeted ICU nutrition. Implementation should prioritize transparency, equity, and workflow integration. Full article
(This article belongs to the Special Issue Nutritional Support for Critically Ill Patients)
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