From the Research
For ICU patients with severe HSV-1 encephalitis, a high-protein, high-calorie enteral nutrition formula is recommended, typically providing 25-30 kcal/kg/day and 1.5-2.0 g/kg/day of protein, as supported by the most recent and highest quality study 1.
Key Considerations
- Continuous feeding is generally preferred over bolus feeding to improve tolerance and reduce aspiration risk.
- The nutrition should be initiated early, within 24-48 hours of ICU admission if hemodynamically stable, and advanced gradually to target rate.
- A standard polymeric formula is appropriate for most patients, but if malabsorption is present, a semi-elemental or elemental formula may be considered.
- Adequate hydration should be maintained, with close monitoring of electrolytes, particularly sodium levels, as SIADH can occur with encephalitis.
Monitoring and Adjustments
- Regular monitoring of gastric residual volumes, bowel function, and nutritional parameters is essential.
- Adjustments to the nutritional plan may be necessary based on the patient's response and tolerance to the formula.
- The patient's nutritional status and overall health should be closely monitored to ensure the best possible outcomes.
Antiviral Therapy
- Antiviral therapy, typically acyclovir 10 mg/kg IV every 8 hours for 14-21 days, should be administered concurrently with nutritional support to treat the underlying HSV-1 infection.
- The use of adjunctive immunomodulatory therapy, such as intravenous immunoglobulin and glucocorticoids, may be considered in severe cases, as suggested by recent studies 2.