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<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Acute skeletal muscle wasting may predict clinical outcomes in critically ill patients. This study aimed to assess acute muscle loss, changes in anthropometric measurements, and the relationship between muscle loss and clinical outcomes in critically ill trauma and surgical patients.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This single‐center, prospective observational study was conducted in critically ill trauma and surgical patients who were expected to stay in the intensive care unit (ICU) for at least 7 days. Rectus femoris cross‐sectional area muscle measurements were performed by bedside ultrasound, and anthropometric measurements were obtained at baseline and 7 days after the first assessment. Length of mechanical ventilation, ICU and hospital stay, and mortality were recorded.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Thirty‐five patients with a mean age of 49.6 ± 18.6 years and 74.1% male were enrolled. The rectus femoris cross‐sectional area, mid‐arm circumference, and calf circumference were reduced at second assessment from baseline (<jats:italic>P</jats:italic> &lt; 0.05). In univariate analysis, muscle loss and changes in anthropometric measurements were not associated with 90‐day mortality (<jats:italic>P</jats:italic> &gt; 0.05).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Muscle loss in critical trauma and surgical patients occurred rapidly during the first week of critical illness. Rectus femoris muscle cross‐sectional area assessment can be used to detect skeletal muscle changes in critically ill patients. Further investigations on the skeletal muscle changes and clinical outcomes need to be conducted.</jats:p></jats:sec>

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Critically ill patients have intense muscle tissue mobilization, and attenuating protein catabolism may contribute to improved outcomes.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate short‐term muscle loss in critically ill patients.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In this prospective observational study, we evaluated the thickness of the rectus femoris muscle by ultrasonography in young and older adults of both sexes admitted to a cardiological intensive care unit within 48 h of admission (baseline) and after 7 days. The results were compared and correlated with anthropometric, clinical, and biochemical parameters. The significance level for all statistical analyses was 0.05.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The final sample comprised 88 patients with a mean age of 66.2 ± 11.8 years. There was an average 13.5% reduction in rectus femoris muscle thickness over the study period (<jats:italic>P</jats:italic> &lt; 0.001), regardless of the thigh circumference maintenance (<jats:italic>P</jats:italic> = 0.229). This reduction occurred even with improved clinical parameters (C‐reactive protein, Simplified Acute Physiology Score) and was greater in patients receiving mechanical ventilation and sedation and in those who died. Regarding nutrition status, malnourished and eutrophic individuals showed greater muscle loss than overweight individuals. There was also an inverse correlation of muscle loss (percentage) with body mass index, arm circumference, and calf circumference (<jats:italic>P</jats:italic> &lt; 0.05), demonstrating that the lower these anthropometric measurements, the higher the muscle loss obtained by ultrasound.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Ultrasonography assessment detected muscle mass loss in the short‐term more sensitively than the anthropometric method. However, it demands caution and further studies demonstrating this analysis.</jats:p></jats:sec>

<jats:title>Abstract</jats:title><jats:p>The timing of nutrition support initiation has the potential to positively impact nutrition and clinical outcomes in infants and children with critical illness. Early enteral nutrition within 24–48 h and attainment of both a 60% energy and protein goal by the end of the first week of pediatric intensive care unit admission are reported to be significantly associated with improved survival in large observational studies. The results of one randomized controlled trial demonstrated increased morbidity in infants and children with critical illness assigned to early vs delayed supplemental parenteral nutrition. Observational studies in this population also suggest increased mortality with exclusive parenteral nutrition and worse nutrition outcomes when parenteral nutrition is delayed. Subsequently, current nutrition support guidelines recommend early enteral nutrition and avoidance of early parenteral nutrition, although the available evidence used to create the guidelines was inadequate to inform bedside nutrition support practice to improve outcomes. These guidelines are limited by the included studies with small numbers and heterogeneity of patients and research design that confound study outcomes and interpretation. This article provides a narrative review of the timing of nutrition support on outcomes in infants and children with critical illness, strategies to optimize timing and adequacy of nutrition support, and literature gaps, including the timing of parenteral nutrition initiation for children with malnutrition and those with contraindications to enteral nutrition and accurate measurement of energy requirements.</jats:p>

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>This study aimed to describe children at risk of prolonged temporary tube feeding and evaluate associations between tube feeding duration and child and health service variables.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A prospective medical hospital records audit was conducted between November 1, 2018, and November 30, 2019. Children at risk of prolonged temporary tube feeding were identified as having a tube feeding duration of &gt;5 days. Information was collected on patient characteristics (eg, age) and service delivery provision (eg, tube exit plans). Data were collected from the pretube decision‐making phase until tube removal (if applicable) or until 4 months after tube insertion.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Descriptively, 211 at‐risk children (median, 3.7 years; interquartile range [IQR], 0.4–7.7) differed from 283 not‐at‐risk children (median age, 0.9 years; IQR, 0.4–1.8) in terms of age, geographical location of residence, and tube exit planning. Medical diagnoses of neoplasms, congenital abnormalities, perinatal problems, and digestive system diseases in the at‐risk group were individually associated with longer than average tube feeding duration, as were the primary reasons for tube feeding of nonorganic growth faltering and inadequate oral intake related to neoplasms. Yet, variables independently associated with greater odds of lengthier tube feeding durations were consultations with a dietitian, speech pathologist, or interdisciplinary feeding team.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Children at risk of prolonged temporary tube feeding access interdisciplinary management because of their complexity. Identified descriptive differences between at‐risk and not‐at‐risk children may be useful when selecting patients for tube exit planning and developing tube feeding management education programs for health professionals.</jats:p></jats:sec>