Medical nutrition therapy for critically ill patients with cardiorenal syndrome: A case series

Cardiorenal syndrome (CRS) in critically ill patients causes metabolic stress responses that result in hypercatabolism, thereby increasing the risk of malnutrition. Herein, we assessed the effects of medical nutrition therapy in terms of providing adequate energy, attenuating metabolic responses to stress, and preserving muscle mass, as well as monitored improvements in nutritional status and functional capacity. This case series included four critically ill patients with CRS who were admitted to Dr. Cipto Mangunkusumo Hospital. Medical nutrition therapy was provided on the basis of the nutrition guidelines for critically ill patients. Specifically, early enteral nutrition (EEN) was provided with a target of 25-30 kcal/kg body weight (BW), protein contents of 1.2-2 g/kg BW, lipid contents of 20%-30%, and carbohydrate contents of at least 2 g/kg BW/day. Patients were aged 24-62 years with male to female ratio of 1:3 and obese to normoweight ratio of 3:1. All patients received EEN and met macronutrient requirements based on the nutrition guidelines. The duration of mechanical ventilation in 3 patients was 14-21 days, and 2 of the patients were successfully weaned. Improvements in respiratory function were also observed in patients without mechanical ventilation. Weight loss of <10% occurred in all patients, but nutritional status only deteriorated in one patient. Medical nutrition therapy preserves nutritional status and improves the functional capacity of critically ill patients with CRS.