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. 2022 Jan;46(1):12-41.
doi: 10.1002/jpen.2267. Epub 2022 Jan 3.

Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition

Charlene Compher  1 , Angela L Bingham  2   3 , Michele McCall  4 , Jayshil Patel  5 , Todd W Rice  6 , Carol Braunschweig  7 , Liam McKeever  7
Affiliations

Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition

Charlene Compher et al. JPEN J Parenter Enteral Nutr. 2022 Jan.

Erratum in

Abstract

Background: This guideline updates recommendations from the 2016 American Society for Parenteral and Enteral Nutrition (ASPEN)/Society of Critical Care Medicine (SCCM) critical care nutrition guideline for five foundational questions central to critical care nutrition support.

Methods: The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) process was used to develop and summarize evidence for clinical practice recommendations. Clinical outcomes were assessed for (1) higher vs lower energy dose, (2) higher vs lower protein dose, (3) exclusive isocaloric parenteral nutrition (PN) vs enteral nutrition (EN), (4) supplemental PN (SPN) plus EN vs EN alone, (5A) mixed-oil lipid injectable emulsions (ILEs) vs soybean oil, and (5B) fish oil (FO)-containing ILE vs non-FO ILE. To assess safety, weight-based energy intake and protein were plotted against hospital mortality.

Results: Between January 1, 2001, and July 15, 2020, 2320 citations were identified and data were abstracted from 36 trials including 20,578 participants. Patients receiving FO had decreased pneumonia rates of uncertain clinical significance. Otherwise, there were no differences for any outcome in any question. Owing to a lack of certainty regarding harm, the energy prescription recommendation was decreased to 12-25 kcal/kg/day.

Conclusion: No differences in clinical outcomes were identified among numerous nutrition interventions, including higher energy or protein intake, isocaloric PN or EN, SPN, or different ILEs. As more consistent critical care nutrition support data become available, more precise recommendations will be possible. In the meantime, clinical judgment and close monitoring are needed. This paper was approved by the ASPEN Board of Directors.

Keywords: adult; bacteremia; critical care; critical illness; energy; enteral nutrition; guideline; intensive care unit; length of stay; lipid; mechanical ventilation; mortality; nutrition; nutrition support; parenteral nutrition; pneumonia; protein; randomized controlled trial.

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References

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