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Review
. 2025 Jan 2:388:e077979.
doi: 10.1136/bmj-2023-077979.

Nutritional Support in the ICU

Affiliations
Review

Nutritional Support in the ICU

Jean Reignier et al. BMJ. .

Abstract

Critical illness is a complex condition that can have a devastating impact on health and quality of life. Nutritional support is a crucial component of critical care that aims to maintain or restore nutritional status and muscle function. A one-size-fits-all approach to the components of nutritional support has not proven beneficial. Recent randomized controlled trials challenge the conventional strategy and support the safety and potential benefits of below-usual calorie and protein intakes at the early, acute phase of critical illness. Further research is needed to define optimal nutritional support throughout the intensive care unit stay. Individualized nutritional strategies relying on risk assessment tools or biomarkers deserve further investigation in rigorously designed, large, multicenter, randomized, controlled trials. Importantly, although nutritional support is crucial, it might not be sufficient to enhance the recovery of critically ill patients. Thus, achieving the greatest efficacy may require individualized nutritional support combined with early, prolonged physical rehabilitation within a multimodal, holistic care program throughout the patient's recovery journey.

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Conflict of interest statement

Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: YMA is the principal investigator for the REPLENISH (Replacing Protein via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients) trial, NCT04475666, which is funded by King Abdullah International Medical Research Center, Riyadh, Saudi Arabia and was the principal investigator for the PERMIT trial;37 TWR received consulting fees from Nestle, Baxter, Cumberland Pharmaceuticals, and Sanofi and was the principal investigator for the EDEN trial;1416 JR was the principal investigator for the NUTRIREA-1, -2, -3, and -4 trials;13102132 MC was the principal investigator of the EPaNIC trial.12

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