Guidelines for the provision of nutrition support therapy in the adult critically ill patient: the American Society for Parenteral and Enteral Nutrition
Open accessAbstract
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.
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ASPEN and the Society of Critical Care Medicine favor individualized protein intake targets within the 1.2-2.0 g/kg/d range, with cautious consideration of higher intake in select patients with burns, trauma, or obesity.
“the most appropriate protein intake approaches for the CICU population are likely those in alignment with evidence-based guidance from ASPEN and the Society of Critical Care Medicine, which favor individualized protein intake targets within the 1.2– to 2.0–g·kg−1·d−1 range, with cautious consideration of higher intake in select patients with burns, trauma, or obesity.148–150”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [149]
Recent guidelines written by ESPEN, ASPEN/SCCM, the Canadian Critical Care Practice Guideline group and the ESICM working group were considered when formulating the updated ESPEN recommendations.
“Recent guidelines written by ESPEN [1,2], ASPEN/SCCM [32], the Canadian Critical Care Practice Guideline group [29] and the most recent clinical practice guidelines on early EN in critically ill patients by the ESICM working group on gastrointestinal function [13] were considered when formulating the updated ESPEN recommendations [4].”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [32]
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- Authors
- Compher, C., Bingham, A. L., McCall, M., Patel, J., Rice, T. W., Braunschweig, C., & McKeever, L.
- Affiliations
- University of Pennsylvania (US)
- University of the Sciences (US)
- St. Michael's Hospital (CA)
- Medical College of Wisconsin (US)
- Vanderbilt University (US)
- University of Illinois Chicago (US)
- Corresponding author
- McKeever, Liam
- ORCID
- Venue
- Journal of Parenteral and Enteral Nutrition
- Publisher
- Wiley
- Published
- 2022-01
- Volume
- 46
- Issue
- 1
- Pages
- 12-41
- ISSN
- 0148-6071 (ISSN-L)
- 1941-2444
- OpenAlex
- W3212404418
- Cited by
- 747
- References
- 9
- Citations by year
- 2026: 198 · 2025: 176 · 2024: 178 · 2023: 128 · 2022: 62 · 2021: 2
- FWCI
- 59.11
- Type
- journal article
- Language
- en
- Update notices
- correction (2022-06-19)
- Open access
- bronze
- doi.org
- Locations
- Journal of Parenteral and Enteral Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- critical care nutrition, nutrition support therapy, critically ill adults, energy dose, protein dose, parenteral nutrition, enteral nutrition, lipid emulsions, fish oil, soybean oil, pneumonia, in-hospital mortality
- MeSH terms
- Critical Care, Enteral Nutrition, Humans, Parenteral Nutrition, Critical Illness, Nutritional Support
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