Expert consensus‑based clinical practice guidelines for nutritional support in the intensive care unit: the French Intensive Care Society (SRLF) and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP)

Jean Reignier^{1

2}, Benedicte Gaillard-Le Roux³, Pierre François Dequin⁴, Valeria A Bertoni Maluf⁵, Julien Bohe⁶, Michael P Casaer⁷, Agathe Delbove⁸, Claire Dupuis^{9

10}, Eric Fontaine¹¹, Prescillia Gamon¹², Coralie Grange¹³, Nicholas Heming¹⁴, Melissa Jezequel¹⁵, Adam Jirka¹⁶, Corinne Jotterand Chaparro⁵, Michael Landais¹⁷, Nolwenn Letouze¹⁸, Claire Morice¹⁹, Olivier Pantet²⁰, Julie Pellecer²¹, Gael Piton²², Shancy Rooze²³, Julie Starck²⁴, Jean-Marc Tadie²⁵, Fabienne Tamion^{26

27}, Ronan Thibault^{28

29}, Frédéric Valla³⁰, Thierry Vanderlinden³¹, Arnaud W Thille³², Nadia Aissaoui³³

Affiliations

¹ Movement-Interactions-Performance (MIP), UR 4334; Nantes University, Nantes, France. jean.reignier@chu-nantes.fr.
² Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. jean.reignier@chu-nantes.fr.
³ Pediatric Intensive Care Unit, Nantes University Hospital, Nantes, France.
⁴ Intensive Care Unit, Inserm U1100, Bretonneau University Hospital, Tours, France.
⁵ Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Carouge, Switzerland.
⁶ Medical Intensive Care Unit, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Hospices Civils de Lyon, Lyon, France.
⁷ Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium.
⁸ Medical-Surgical Intensive Care Unit, CHBA Vannes, Vannes, France.
⁹ Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France.
¹⁰ Human Nutrition Unit, Clermont Auvergne University, INRAe, CRNH Auvergne, Clermont-Ferrand, France.
¹¹ Basic and Applied Bioenergetics Laboratory, Joseph Fourier University, Grenoble, France.
¹² Medical Intensive Care Unit, Grenoble University Hospital, La Tronche, France.
¹³ Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis University Hospital, AP-HP, Paris, France.
¹⁴ Department of Intensive Care, Raymond Poincaré University Hospital, AP-HP, IHU Prometheus, Versailles Saint Quentin University-Paris Saclay University, Garches, France.
¹⁵ Cardiac Intensive Care Unit, Saint-Brieuc Hospital, Saint-Brieuc, France.
¹⁶ Hepato-Gastroenterology and Digestive Oncology, IMAD, Nantes University Hospital, Nantes, France.
¹⁷ Medical-Surgical Intensive Care Unit, Community Hospital Centre, Le Mans, France.
¹⁸ Pediatric Intensive Care Unit, Caen University Hospital, Caen, France.
¹⁹ Pediatric and Neonatal Intensive Care Unit; Pediatric Specialties Division, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.
²⁰ Department of Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland.
²¹ Université Paris-Saclay, Faculté de Médecine, Service de Medecine Intensive-Reanimation, Hôpital de Bicêtre, AP-HP, DMU 4 CORREVE Maladies du cœur et des Vaisseaux, Le Kremlin-Bicêtre, France.
²² Medical Intensive Care Unit, SINERGIES, Besançon University Hospital, Franche Comté University, Besançon, France.
²³ Paediatric Intensive Care Unit, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles, Bruxelles, Belgium.
²⁴ Neonatal and Pediatric Intensive Care Unit, Trousseau University Hospital, AP-HP, Paris, France.
²⁵ Intensive Care Unit, Pontchaillou University Hospital, UMR 1236, Rennes University, INSERM, Etablissement Français du Sang Bretagne, Rennes, France.
²⁶ Medical Intensive Care Unit, Rouen University Hospital, Rouen, France.
²⁷ INSERM U1096, Rouen University, Rouen, France.
²⁸ Department of Endocrinology-Diabetology-Nutrition, Home Parenteral Nutrition Centre, CHU Rennes, Rennes, France.
²⁹ INRAE, INSERM, Univ Rennes, Nutrition Metabolism Cancer NuMeCan, Rennes, France.
³⁰ Pediatric Intensive Care, Women's and Children's Hospital, Hospices Civils de Lyon, Lyon-Bron, France.
³¹ Intensive Care Unit, Lille Catholic Institute Hospital Group, FMMS - ETHICS EA 7446, Lille Catholic University, Lille, France.
³² Intensive Care Unit, Poitiers University Hospital, Réanimation, Poitiers, France.
³³ Cardiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Cité University, Paris, France.

PMID: 40665004
PMCID: PMC12263543
DOI: 10.1186/s13613-025-01509-0

Review

Expert consensus‑based clinical practice guidelines for nutritional support in the intensive care unit: the French Intensive Care Society (SRLF) and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP)

Jean Reignier et al. Ann Intensive Care. 2025.

. 2025 Jul 15;15(1):99.

doi: 10.1186/s13613-025-01509-0.

Authors

Affiliations

¹ Movement-Interactions-Performance (MIP), UR 4334; Nantes University, Nantes, France. jean.reignier@chu-nantes.fr.
² Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. jean.reignier@chu-nantes.fr.
³ Pediatric Intensive Care Unit, Nantes University Hospital, Nantes, France.
⁴ Intensive Care Unit, Inserm U1100, Bretonneau University Hospital, Tours, France.
⁵ Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Carouge, Switzerland.
⁶ Medical Intensive Care Unit, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Hospices Civils de Lyon, Lyon, France.
⁷ Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium.
⁸ Medical-Surgical Intensive Care Unit, CHBA Vannes, Vannes, France.
⁹ Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France.
¹⁰ Human Nutrition Unit, Clermont Auvergne University, INRAe, CRNH Auvergne, Clermont-Ferrand, France.
¹¹ Basic and Applied Bioenergetics Laboratory, Joseph Fourier University, Grenoble, France.
¹² Medical Intensive Care Unit, Grenoble University Hospital, La Tronche, France.
¹³ Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis University Hospital, AP-HP, Paris, France.
¹⁴ Department of Intensive Care, Raymond Poincaré University Hospital, AP-HP, IHU Prometheus, Versailles Saint Quentin University-Paris Saclay University, Garches, France.
¹⁵ Cardiac Intensive Care Unit, Saint-Brieuc Hospital, Saint-Brieuc, France.
¹⁶ Hepato-Gastroenterology and Digestive Oncology, IMAD, Nantes University Hospital, Nantes, France.
¹⁷ Medical-Surgical Intensive Care Unit, Community Hospital Centre, Le Mans, France.
¹⁸ Pediatric Intensive Care Unit, Caen University Hospital, Caen, France.
¹⁹ Pediatric and Neonatal Intensive Care Unit; Pediatric Specialties Division, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.
²⁰ Department of Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland.
²¹ Université Paris-Saclay, Faculté de Médecine, Service de Medecine Intensive-Reanimation, Hôpital de Bicêtre, AP-HP, DMU 4 CORREVE Maladies du cœur et des Vaisseaux, Le Kremlin-Bicêtre, France.
²² Medical Intensive Care Unit, SINERGIES, Besançon University Hospital, Franche Comté University, Besançon, France.
²³ Paediatric Intensive Care Unit, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles, Bruxelles, Belgium.
²⁴ Neonatal and Pediatric Intensive Care Unit, Trousseau University Hospital, AP-HP, Paris, France.
²⁵ Intensive Care Unit, Pontchaillou University Hospital, UMR 1236, Rennes University, INSERM, Etablissement Français du Sang Bretagne, Rennes, France.
²⁶ Medical Intensive Care Unit, Rouen University Hospital, Rouen, France.
²⁷ INSERM U1096, Rouen University, Rouen, France.
²⁸ Department of Endocrinology-Diabetology-Nutrition, Home Parenteral Nutrition Centre, CHU Rennes, Rennes, France.
²⁹ INRAE, INSERM, Univ Rennes, Nutrition Metabolism Cancer NuMeCan, Rennes, France.
³⁰ Pediatric Intensive Care, Women's and Children's Hospital, Hospices Civils de Lyon, Lyon-Bron, France.
³¹ Intensive Care Unit, Lille Catholic Institute Hospital Group, FMMS - ETHICS EA 7446, Lille Catholic University, Lille, France.
³² Intensive Care Unit, Poitiers University Hospital, Réanimation, Poitiers, France.
³³ Cardiology Department, European Georges Pompidou University Hospital, AP-HP, Paris Cité University, Paris, France.

PMID: 40665004
PMCID: PMC12263543
DOI: 10.1186/s13613-025-01509-0

Abstract

The objective of this work was to develop guidelines for nutritional support in critically ill adults and children (excluding neonates and burn patients) unable to maintain an adequate oral intake. We aimed to provide up-to-date recommendations based on high-level evidence including the results of recent landmark randomized controlled trials. Experts from the French Intensive Care Society (SRLF), the French Society of Clinical Nutrition and Metabolism (SFNCM), and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP) used the GRADE methodology to develop the guidelines. Twenty-four Patient Intervention Comparator Outcome (PICO) questions were identified, resulting in 34 adult and 29 pediatric recommendations. Of the 34 recommendations for adults, three were based on high-level evidence, 12 on moderate-level evidence, and 19 on expert opinion. The corresponding numbers for the 29 pediatric recommendations were one, five, and 23. All recommendations achieved strong agreement among the experts. These guidelines emphasize the importance of individualized nutritional support strategies that incorporate recent high-quality evidence to optimize the outcomes of critically ill patients.

Keywords: Adults; Calories; Children; Critical illness; Enteral nutrition; Nutritional support; Parenteral nutrition; Proteins; Recommendations.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: JR: funding from research programs run by the French Ministry of Health (NUTRIREA-2, NUTRIREA-3 and NUTRIREA-4 trials). BGLR: consulting fees from Fresenius. PFD: funding from research programs run by the French Ministry of Health, equipment loans from Aerogen and Fisher and Paykel, consulting fees from Aridis Pharmaceuticals. EF: consulting and training services fees from Baxter, Nutricia, Fresenius, Aguettant and BBraun. RT: consulting fees from Baxter, Fresenius-Kabi and Nutricia; writing reports or patient tools for Aguettant, Boehringer Ingelheim and Roche; speaker at symposia or scientific meetings organized by Astra-Zeneca, Baxter, BBraun, Fresenius-Kabi, Lactalis, Nestlé, Novonordisk, Nutricia, or Shire; fees for the design of the SEFI® (KNoë-Groupe Get, Le Kremlin Bicêtre, France). FV: consulting fees from Baxter, Nutricia and Nestle Health Science. TV: consulting and training fees from Baxter and Nutricia; travel expense for congress: Nestlé, Sysmed and Homeperf. The remaining authors declare no conflict of interest.

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Expert consensus‑based clinical practice guidelines for nutritional support in the intensive care unit: the French Intensive Care Society (SRLF) and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP)

Affiliations

Expert consensus‑based clinical practice guidelines for nutritional support in the intensive care unit: the French Intensive Care Society (SRLF) and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP)

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