Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)

McClave, Stephen A.; Taylor, Beth E.; Martindale, Robert G.; Warren, Malissa M.; Johnson, Debbie R.; Braunschweig, Carol; McCarthy, Mary S.; Davanos, Evangelia; Rice, Todd W.; Cresci, Gail A.; Gervasio, Jane M.; Sacks, Gordon S.; Roberts, Pamela R.; Compher, Charlene; the Society of Critical Care Medicine; the American Society for Parenteral and Enteral Nutrition

doi:10.1177/0148607115621863

Cited by 3,982Clinical Nutrition and GastroenterologyHyperglycemia and glycemic control in critically ill and hospitalized patientsSepsis Diagnosis and Treatment

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)

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McClave, Stephen A., Taylor, Beth E., Martindale, Robert G., Warren, Malissa M., Johnson, Debbie R., Braunschweig, Carol, McCarthy, Mary S., Davanos, Evangelia +8 more·2016·Journal of Parenteral and Enteral Nutrition

DOI 10.1177/0148607115621863

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Abstract

This document represents the first collaboration between 2 organizations-the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine-to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and <18 years) expected to require a length of stay >2-3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevance. The PubMed/MEDLINE search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1661 citations. In total, the search for clinical trials yielded 1107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline. We used the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation) to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutrition assessment-particularly, the detection of malnourished patients who are most vulnerable and therefore may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery are areas of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears to be beneficial. Immunonutrition cannot be currently recommended. Overall, the pediatric critical care population is heterogeneous, and a nuanced approach to individualizing nutrition support with the aim of improving clinical outcomes is necessary.

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It is recommended to initiate enteral feeding within 24-48 hours of intensive care unit admission for critically ill patients.
“Therefore, it is recommended to initiate enteral feeding (EF) within 24–48 hours of intensive care unit (ICU) admission for critically ill patients [4,5].”
From The impact of enteral feeding intolerance on the prognosis of patients with septic shock in South Korea (2025) · cites this paper as [4]
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 [148]

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Authors: McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., Gervasio, J. M., Sacks, G. S., Roberts, P. R., Compher, C., the Society of Critical Care Medicine, & the American Society for Parenteral and Enteral Nutrition
Affiliations: University of Louisville (US)
Barnes-Jewish Hospital (US)
Oregon Health & Science University (US)
Portland VA Medical Center (US)
UW Health University Hospital (US)
University of Illinois Chicago (US)
Madigan Army Medical Center (US)
Brooklyn Hospital Center (US)
Vanderbilt University (US)
Butler University (US)
Auburn University (US)
Corresponding author: McClave, Stephen A.
Compher, Charlene
ORCID: McClave, Stephen A.
Taylor, Beth E.
Martindale, Robert G.
McCarthy, Mary S.
Rice, Todd W.
Cresci, Gail A.
Roberts, Pamela R.
Compher, Charlene
Venue: Journal of Parenteral and Enteral Nutrition
Publisher: Wiley
Published: 2016-01-14
Volume: 40
Issue: 2
Pages: 159-211
ISSN: 0148-6071 (ISSN-L)
1941-2444
DOI: 10.1177/0148607115621863
OpenAlex: W2159519210
Cited by: 3,982
References: 658
Citations by year: 2026: 244 · 2025: 298 · 2024: 297 · 2023: 353 · 2022: 359 · 2021: 365 · 2020: 382 · 2019: 337 · 2018: 286 · 2017: 267 · 2016: 173 · 2015: 139 · 2014: 152 · 2013: 89 · 2012: 95
FWCI: 370.96
Type: journal article
Language: en
Update notices: correction (2016-09-15)
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Journal of Parenteral and Enteral Nutrition (publishedVersion)
PubMed (publishedVersion)
Digital Commons @ Butler University (Butler University) (submittedVersion)
Funders: March of Dimes Foundation
American Society for Parenteral and Enteral Nutrition
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 › Epidemiology › Sepsis Diagnosis and Treatment
Keywords: nutrition support therapy, critically ill children, pediatric intensive care, nutritional assessment, malnutrition, energy requirements, protein intake, indirect calorimetry, enteral nutrition, parenteral nutrition, immunonutrition
MeSH terms: Acute Disease, Energy Intake, Chronic Disease, Critical Care, Dietary Carbohydrates, Dietary Fats, Enteral Nutrition, Humans, Lung Diseases, Obesity, Pancreatitis, Parenteral Nutrition, Postoperative Care, Nutrition Assessment, Randomized Controlled Trials as Topic, Critical Illness, Liver Failure, Sepsis, Renal Insufficiency, Observational Studies as Topic

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Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)

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