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Feeding the Critically Ill Patient

McClave, Stephen A. MD1; Martindale, Robert G. MD, PhD2; Rice, Todd W. MD, MSc3; Heyland, Daren K. MD4

doi: 10.1097/CCM.0000000000000654
Concise Definitive Review
SCCM Podcast

Objective: Critically ill patients are usually unable to maintain adequate volitional intake to meet their metabolic demands. As such, provision of nutrition is part of the medical care of these patients. This review provides detail and interpretation of current data on specialized nutrition therapy in critically ill patients, with focus on recently published studies.

Data Sources: The authors used literature searches, personal contact with critical care nutrition experts, and knowledge of unpublished data for this review.

Study Selection: Published and unpublished nutrition studies, consisting of observational and randomized controlled trials, are reviewed.

Data Extraction: The authors used consensus to summarize the evidence behind specialized nutrition.

Data Synthesis: In addition, the authors provide recommendations for nutritional care of the critically ill patient.

Conclusions: Current evidence suggests that enteral nutrition, started as soon as possible after acute resuscitative efforts, may serve therapeutic roles beyond providing calories and protein. Although many new studies have further advanced our knowledge in this area, the appropriate level of standardization has not yet been achieved for nutrition therapy, as it has in other areas of critical care. Protocolized nutrition therapy should be modified for each institution based on available expertise, local barriers, and existing culture in the ICU to optimize evidence-based nutrition care for each critically ill patient.

1Department of Medicine, University of Louisville School of Medicine, Louisville, KY.

2Department of Surgery, Oregon Health Sciences University, Portland, OR.

3Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, TN.

4Department of Medicine, Queens University, Kingston, ON, Canada.

Dr. McClave served as board member for National Board of Physician Nutrition Specialists, consulted for Covidien, and lectured for Nestle Abbott. Dr. Rice served as a board member for Avisa Pharma; consulted for Avisa Pharma and GlaxoSmithKline, LLC; received support for travel from the American Society of Parenteral and Enteral Nutrition; and received support for article research from the National Institutes of Health (NIH). His institution received grant support from the NIH. Dr. Heyland consulted for GlaxoSmithKline, lectured for Abbott and Nestle, and received support from Nestle and Fresenius Kabi (Knowledge translation activities). His institution received grant support from Nestle, Abbott, Baxter, and Fresenius Kabi. Dr. Martindale has disclosed that he does not have any potential conflicts of interest.

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© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins