Logistical issues

The purpose of this study is to evaluate whether a nutritional strategy is effective in critically ill patients with cancer diagnosed with refeeding syndrome.

Refeeding syndrome is a clinical entity triggered by the introduction of calories in chronically undernourished patients. A number of organs may be affected due to imbalance of fluids and electrolytes. In the intensive care setting, there are no formal guidelines to recommend the appropriate treatment of this condition. The aim of this study is to evaluate the implementation of a nutritional protocol to address cancer patients admitted to the ICU with refeeding syndrome.

Inclusion Criteria:

• Initiation of any type of nutrition (enteral, parenteral or glucose solution of at least 10% concentration) in the ICU in the last 48 hours;
• Reduction of serum phosphorus to a level below 2.5mg/dL with a drop above 0.5mg/dL compared to a previous measurement;
• Caloric intake greater than 500kcal in the last 24 hours;
• Central venous access for electrolyte replacement;
• Signature of the informed consent form.

Exclusion Criteria:

• Use of enteral or parenteral nutrition before ICU admission;
• Prediction of ICU discharge in the following 2 days;
• End-stage renal disease;
• Admission for diabetic ketoacidosis or hyperosmolar hyperglycemic state;
• Recent treatment of hyperphosphatemia;
• Parathyroidectomy surgery;
• Participation in another study;
• Refusal to participate in the study.