ESPEN guidelines on parenteral nutrition: intensive care
Open accessAbstract
Nutritional support in the intensive care setting represents a challenge but it is fortunate that its delivery and monitoring can be followed closely. Enteral feeding guidelines have shown the evidence in favor of early delivery and the efficacy of use of the gastrointestinal tract. Parenteral nutrition (PN) represents an alternative or additional approach when other routes are not succeeding (not necessarily having failed completely) or when it is not possible or would be unsafe to use other routes. The main goal of PN is to deliver a nutrient mixture closely related to requirements safely and to avoid complications. This nutritional approach has been a subject of debate over the past decades. PN carries the considerable risk of overfeeding which can be as deleterious as underfeeding. Therefore the authors will present not only the evidence available regarding the indications for PN, its implementation, the energy required, its possible complementary use with enteral nutrition, but also the relative importance of the macro- and micronutrients in the formula proposed for the critically ill patient. Data on long-term survival (expressed as 6 month survival) will also be considered a relevant outcome measure. Since there is a wide range of interpretations regarding the content of PN and great diversity in its practice, our guidance will necessarily reflect these different views. The papers available are very heterogeneous in quality and methodology (amount of calories, nutrients, proportion of nutrients, patients, etc.) and the different meta-analyses have not always taken this into account. Use of exclusive PN or complementary PN can lead to confusion, calorie targets are rarely achieved, and different nutrients continue to be used in different proportions. The present guidelines are the result of the analysis of the available literature, and acknowledging these limitations, our recommendations are intentionally largely expressed as expert opinions.
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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 [2]
Intravenous fat emulsions based solely on soybean oil (rich in 18-carbon omega-6 FA) have likely pro-inflammatory effects.
“The use of intravenous fat emulsions based solely on soybean oil (rich in 18-carbon omega-6 FA) should be avoided due to their likely pro-inflammatory effects [2].”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [2]
Providing micronutrients to include the full range of trace elements and vitamins is an integral part of nutritional support as stated in the 2009 guidelines.
“Providing micronutrients to include the full range of trace elements and vitamins is an integral part of nutritional support as stated in the 2009 guidelines [2].”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [2]
Commercially available PN solutions contain no micronutrients for stability reasons: this requires their separate prescription.
“Parenteral and enteral feeding preparations differ in that commercially available PN solutions contain no micronutrients for stability reasons: this requires their separate prescription [2].”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [2]
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- Authors
- Singer, P., Berger, M. M., Van den Berghe, G., Biolo, G., Calder, P., Forbes, A., Griffiths, R., Kreyman, G., Leverve, X., & Pichard, C.
- Affiliations
- Rabin Medical Center (IL)
- University of Trieste (IT)
- University of Southampton (GB)
- University College London (GB)
- University of Liverpool (GB)
- Université Joseph Fourier (FR)
- University Hospital of Geneva (CH)
- Corresponding author
- Pichard, Claude
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2009-08
- Volume
- 28
- Issue
- 4
- Pages
- 387-400
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W1973817122
- Cited by
- 1,907
- References
- 13
- Citations by year
- 2026: 19 · 2025: 24 · 2024: 26 · 2023: 51 · 2022: 46 · 2021: 75 · 2020: 60 · 2019: 92 · 2018: 126 · 2017: 141 · 2016: 140 · 2015: 223 · 2014: 223 · 2013: 148 · 2012: 140
- FWCI
- 141.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion)
- Digital Access to Libraries (submittedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion)
- 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
- parenteral nutrition, intensive care, critically ill patients, nutritional support, enteral nutrition, energy requirements, energy expenditure, energy balance, macronutrients, micronutrients, nutritional formula, overfeeding, underfeeding, long-term survival, indications for parenteral nutrition, indirect calorimetry, early enteral nutrition, ESPEN guidelines
- MeSH terms
- Contraindications, Adult, Critical Care, Enteral Nutrition, Humans, Middle Aged, Nutritional Status, Parenteral Nutrition, Treatment Outcome, Evidence-Based Medicine, Malnutrition, Young Adult
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