Dietitian | @SCCMSE & @GASPENGa & @ASPEN_nutrition | #WhatRDsDo #ICUNutrition | She/Her | Views my own. https://xitter.cf/t.co/NqEKSrXg8Z
Atlanta, GA
Joined March 2009
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You can also find me where the ☁️ is 🔵! #ICUNutrition #WhatRDsDo
👉ashleydepriestrd
Spent my morning in rounds w/ one of our RDs. Every care team needs a RD lens. When RDs join daily rounds, we catch nutrient gaps, optimize feeding regimens, & tailor plans to each pt’s comorbidities. This not only improves care, but also supports d/charge planning👉 🔻 LOS
LR vs PN = no difference in infection rate! (Per four, large RCT)
@DrKristaHaines
@GASPENGa
#GASPEN26
I saw someone put their colonoscopy prep into a ninja slushy machine and I honestly feel like that is the exact energy we need to reform hospital food service.
When hospitals talk about 📉 readmissions, nutrition is often missing from the conversation.
Yet individualized nutrition therapy has been shown to 📉 nonelective readmissions by ~25–35% across multiple trials.
#WhatRDsDo
Dietitians are the best clinicians to help provide precision nutrition!
We must do better at tying our work to meaningful outcomes as well.
This seems like a great place to start.
#whatRDsdo
One of the most important ICU rehabilitation trials in years just challenged a belief many of us have held for decades…🚨
Is more protein, combined with early exercise, actually better during critical illness?
For years, many of us believed that if some protein and exercise were good in the ICU, more must be better.
The new NEXIS Trial challenges that assumption.
Researchers tested:
✅ Early in-bed cycling
✅ Intravenous amino acids targeting ~2.0–2.5 g/kg/day of protein
The result?
No significant improvement in post-ICU physical function compared with usual care.
But this doesn’t mean protein or rehabilitation aren’t important.
Recent randomized trials suggest the optimal protein dose during acute critical illness may actually be lower than many thought.
📌 PRECISe Trial (Lancet): ~1.2 g/kg/day was associated with better post-ICU physical function than higher protein doses.
📌 Our randomized trial (PMID: 39018085): Patients receiving 1.2–1.5 g/kg/day had the best post-ICU physical function, outperforming those receiving ~2.0 g/kg/day.
The emerging message:
➡️ More protein isn’t automatically better.
➡️ More exercise isn’t automatically better.
➡️ Precision and personalization are the future.
Our NIH R01- and SCCM-funded REMM-HIIT Trial (NCT04664101) is testing CPET VO₂peak-guided rehabilitation in post-ICU/hospital patients. We’ve shown that CPET VO₂peak testing is feasible in ICU survivors, and our pilot data demonstrate 25–50% improvements in VO₂peak within 4–12 weeks, even in very debilitated patients using home-based, real-time tele-rehabilitation.
The future isn’t about giving every patient the highest protein dose.
It’s about giving the right nutrition and exercise, to the right patient, at the right time.
That means targeting protein needs (potentially with BIA) and personalizing exercise using CPET VO₂peak.
Negative trials don’t close the book—they help us ask better questions and move toward precision nutrition and rehabilitation.
❓Should ICU protein targets shift toward ~1.2–1.5 g/kg/day during acute critical illness based on NEXIS, PRECISe, and these newer data?
I’d love to hear your thoughts in comments 👇
Follow up question:
If we’re worried enough about a pts nutrition status that we start “banana bag” + dextrose, why don’t we just start PPN?
1. Anabolic resistance
2. Urea‐Cycle Overload
3. Shutting Down Autophagy
4. Fueling a Metabolic Fire: CO₂, Hyperglycemia, Mitochondrial Strain
Read more about why protein should be limited in the acute phase:
open.substack.com/pub/adepri…
A missed opportunity for nutrition intervention is before/after dental surgeries, particularly in the elderly. Profound and severe malnutrition can happen quickly when you can’t chew or even drink due to pain.
For years I pushed "enteral nutrition first, PN after 7 days."
Today, the conversation is becoming more nuanced: If enteral feeding isn't feasible, early short term parenteral nutrition may be a reasonable (and safe!) option.
Evidence evolves. Our practice should too.
Low BMI has never been a prerequisite for malnutrition.
The growing emphasis on muscle mass, inflammation, and reduced intake reflects what clinicians have known for years: nutrition status is more complex than weight.
A patient can have obesity.
A patient can have severe muscle loss.
Both statements can be true.
That's why diagnosing malnutrition requires looking beyond the scale.
#WhatRDsDo
Protein recommendations in critical illness are finally catching up to physiology.
Instead of rushing to high protein on day one, we're increasingly talking about progressive delivery as patients stabilize.
Critical illness isn't static. Nutrition shouldn't be either.
The phrase "feed the gut" has served us well.
But "feed the patient" may be the more important principle.
Sometimes that means enteral nutrition. Sometimes it means parenteral nutrition.
Physiology should win over dogma.
Indirect calorimetry isn't just a research tool.
If we're serious about personalized ICU nutrition, measuring energy expenditure may be one of the biggest opportunities to move beyond educated guesses.
Are you using IC? How often do you measure?
One of the most important roles of the clinical RD isn't simply knowing the evidence, it's translating it into better patient care.
In the ICU, it's easy to assume that "more protein must be better." But the latest evidence tells a more nuanced story:
substack.com/@adepriest/note…
We've spent years asking "How many calories, how much protein should we give?"
Maybe the better question is "When is the right time to give them?"
The NUTRIREA-3 trial is another reminder that timing may matter as much as dose in the ICU.
#WhatRDsDo
Nutrition is a science.
Inpatient nutrition requires knowledge, nuance, and close monitoring.
💪Registered Dietitians are the perfect people for the job!
#WhatRDsDo