Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition

Charlene Compher; Angela L Bingham; Michele McCall; Jayshil Patel; Todd W Rice; Carol Braunschweig; Liam McKeever

doi:10.1002/jpen.2267

Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition

JPEN J Parenter Enteral Nutr. 2022 Jan;46(1):12-41. doi: 10.1002/jpen.2267. Epub 2022 Jan 3.

Authors

Charlene Compher¹, Angela L Bingham^{2

3}, Michele McCall⁴, Jayshil Patel⁵, Todd W Rice⁶, Carol Braunschweig⁷, Liam McKeever⁷

Affiliations

¹ Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
² Department of Pharmacy, Cooper University Hospital, Camden, New Jersey, USA.
³ Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA.
⁴ St. Michael's Hospital, Medical/Surgical Intensive Care Unit, Toronto, Ontario, Canada.
⁵ Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁶ Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
⁷ Division of Epidemiology and Biostatistics, Department of Kinesiology and Nutrition, University of Illinois, Chicago, Illinois, USA.

PMID: 34784064
DOI: 10.1002/jpen.2267

Abstract

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.

Keywords: adult; bacteremia; critical care; critical illness; energy; enteral nutrition; guideline; intensive care unit; length of stay; lipid; mechanical ventilation; mortality; nutrition; nutrition support; parenteral nutrition; pneumonia; protein; randomized controlled trial.

MeSH terms

Critical Care
Critical Illness* / therapy
Enteral Nutrition*
Humans
Nutritional Support
Parenteral Nutrition