THINKING BEYOND PROTEIN AND ENERGY NEEDS

Interview with Prof. Elisabeth De Waele, by Meg Marquardt, Nestlé Health Science.

From the Metabolic and Nutritional Issues in the ICU Workshop – 29-30 May 2018, Brussels, Belgium.

MB: I’m here with Doctor Elizabeth Wahle who is a trained general surgeon, an ICU physician, and in addition head of the nutritional department at the Free University of Brussels Hospital. It is here where the metabolism and nutrition course at the Erasmus Hospital in Brussels is taking place and one of the themes that is through to course is trying to impart nutrition as more than just protein and energy needs. Have you go some comment on that Dr Wahle?

EDW: Well I really think that we should consider nutrition as a therapy. We have more and more details and we have more and more proof that when you use nutrition in the correct way you can really alter the outcome of your patient. But on the other hand it’s very important to also make a step in your mind that when you are dealing with nutrition as it is a drug you should pose yourself some very relevant questions, like what’s going to be in the indication? Which kind of drug am I going to use? Is it going to be a diet? Oral supplements? Enteral nutrition? Parenteral nutrition? Combination of all of them? How much to the dosing, how much am I going to give, and when I am going to de-escalate? So when I’m going to stop with one form and switch to another one? So you really have to ask yourself some important questions on this nutrition therapy and this we are really reaching out to people to have more knowledge and also more capacity to really implement it in their daily practice.

MB: How prevalent do you think this is today?

EDW: Well, there’s a huge prevalence of malnutrition in ICUs. We know it by data from the Nutrition Day initiative. So we know that a lot of people are malnourished in our ICUs and they continue to be so for a very long time. So this is very bad because we are such an energy dense and capacity dense environment as an ICU and somehow we are still neglecting this very important part of therapy, being nutrition.

MB: So what are the best steps from here?

EDW: Well I think that everybody has to look at his own practice or her own practice and ask yourself the questions do we have an assessment in place? Do we have screening tools? What is our protocol or which guideline are we following and are we implementing it in a practice? And of course also do some data collection and evaluate your practices to see if you don’t have to change something over the years.

MB: So here at this course there are a lot of experts in this space here, including yourself. It’s fair to say that this is not commonly adopted or commonly understood, why do you think that is when it’s so paramount?

EDW: Well, of course there’s the huge problem with the training of medical students and also even doctors who want to become ICU physicians. So we have it more and more but it still depends on your environment, if you’re exposed to the knowledge yes or no. And if not I think it’s really a mental duty that you go for yourself to get this knowledge and to get those skills because it’s a part of therapy. So everybody has to build a little bricks together to make sure that you are doing the right thing for your patient.

MB: Okay. Do you think industry is going to help?

EDW: I think industry can help because in this domain of medicine it’s really a battle that we do together, because as I just said so many people are not having the therapy they need. There’s no over exposure there, so this is something that we can do together. Also by not only making the products that we would need to optimise our therapy, but also helping providing the knowledge and way how to work with what we provide would be very interesting. So I think it’s a common battle because the field is very big.

MB: And what are the biggest components missing in your view today?

EDW: I think, awareness. Every healthcare practitioner who is active in ICU is responsible for this part of treatment and you cannot neglect it just because you don’t have the knowledge. It’s your mental duty to do so to get the knowledge and to implement it in your clinical practice.

MB: Excellent, thank you very much.

EDW: Thank you for this conversation.