From: Nutrition therapy in critical illness: a review of the literature for clinicians
Guideline | Basis of recommendation | Energy requirements | Protein requirements | Commencement of ENa | Commencement of PN |
---|---|---|---|---|---|
ASPEN/SCCM (2016) | Observational studies, RCTs, and consensus opinion from topic experts | Use IC (quality: very low) In the absence of IC use 25–30 kcal/kg/day (EC) Obesity: hypocaloric nutrition, 65-70% measured requirements by IC. If no IC, BMI 30–50 = 11–14 kcal/kg ABW/day; BMI > 50 = 22–25 kcal/kg IBW/day (EC) | 1.2–2 g/kg/day (quality: very low) Obesity: high protein, BMI 30–40 = 2.0 g/kg IBW/day; BMI ≥ 40 = up to 2.5 g/kg IBW/day (EC) | Early EN (24–48 h) (quality: very low) Patients at low nutrition risk, well-nourished, and/or with low disease severity do not require specialised nutrition therapy over the first week in ICU (EC) Patients at high nutrition risk or severely malnourished, EN should advance to goal as quickly as tolerated over 24–48 h in (while monitoring for refeeding) (quality: very low) | Exclusive PN (when oral intake or EN contraindicated) for patients at low nutrition risk, withhold for the first 7 days (quality: very low) For patients at high nutrition risk or severely malnourished start PN as soon as possible (EC) Supplemental PNb should be considered after 7–10 days if unable to meet > 60% of energy and protein requirements by EN (quality: moderate) |
Canadian Clinical Practice Guidelines (2015) | RCTs and consensus opinion from topic experts | Nil | Nil | Early EN (within 24–48 h) (based on 16 level 2 studiesc) | Exclusive PN (when oral intake or EN contraindicated) should be considered early in nutritionally high-risk patients (based on 6 level 2 studiesc) For patients who are not malnourished, are tolerating some EN, or when PN is indicated for <10 days, low dose PN should be considered (based on 4 level 2 studiesc) Supplemental PNb should be assessed on case-by-case basis (based on 1 level 1 study and 7 level 2 studiesc) |
ESICM clinical practice guidelines (2017) | Observational studies, RCTs, and consensus opinion from topic experts | Nil | Nil | Early EN should be prescribed rather than delaying EN (low-quality evidence) | Nil |
ESPEN (2019) | Observational studies, RCTs, and consensus opinion from topic experts | Use IC (grade Bd) In the absence of IC use VO2 or VCO2 predictive equations (grade 0d) Obesity: if no IC, 20–25 kcal/kg ABW/day (grade 0d) | 1.3 g/kg/day delivered progressively (grade 0d) Obesity: 1.3 g/kg ABW/day (grade 0d) | Early EN (within 48 h) (grade Ad) Hypocaloric nutrition (< 70% of EE) in the early acute phase (ICU day 1–3) (grade Bd) If using IC—isocaloric nutrition (80–100% EE) can be progressively implemented after day 3 (grade 0d) If using predictive equations—hypocaloric nutrition (< 70% of EE) for the first week (grade Bd) | Exclusive PN (when oral intake or EN contraindicated) within 3–7 days (grade Bd) For severely malnourished patients, consider early and progressive PN (grade 0d) Supplemental PNb should be considered on a case-by-case basis (grade 0d) |