ABSTRACTS from 16th International COnference on ... - CRRT Online

C11
Critical Care Management: Nutrition Assessment and Delivery
Educational Objectives:
1. to explain the weak evidence underlying current nutrition guidelines
2. to discuss the results of recent observational and randomized trials
Miet Schetz MD, PhD
8:15-9:45
Wednesday, February 15
Content Description:
Critically ill patients present with or develop malnutrition during their ICU stay. Current guidelines suggest starting
nutrition early, prefering enteral (EN) over parenteral nutrition (PN) and performing efforts to reach the nutritional
target. European and American guidelines disagree on the timing to start PN in addition to insufficient EN.
The evidence for early feeding in ICU patients is very weak. The available randomized trials indeed suggest
reduced complications with PN compared with EN. Although some observational trials suggest that increased
caloric input improves outcomes, there is, on the other hand, accumulating evidence that underfeeding might be
beneficial in ICU patients. This is confirmed by the recent EPaNIC trial comparing early versus late addition of
PN to insufficient EN. This trial is the first adequately powered RCT in the field of ICU nutrition and shows no
survival benefit and increased morbidity and costs with early PN.
Suggested Reading:
1.McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci
G; A.S.P.E.N. Board of Directors; American College of Critical Care Medicine; Society of Critical Care
Medicine. 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.). JPEN 2009; 33:277-316
2.Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, Nitenberg G, van den Berghe G,
Wernerman J; DGEM (German Society for Nutritional Medicine), Ebner C, Hartl W, Heymann C, Spies C;
ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition:
Intensive care. Clin Nutr. 2006; 25: 210-23
3.Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, Griffiths R, Kreyman G, Leverve X,
Pichard C, ESPEN. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009; 28: 387-400
4.Koretz RL. Enteral nutrition: a hard look at some soft evidence. Nutr Clin Pract. 2009; 24: 316-24
5.Koretz RL. Parenteral nutrition and urban legends. Curr Opin Gastroenterol. 2008; 24: 210-4
6.Casaer MP, Mesotten D, Hermans G, Wouters P, Schetz M, Meyfroidt G, Van Cromphaut S, Ingels C,
Meerseman Ph, Muller J, Vlasselaers D, Debaveye Y, Desmet L, Dubois J, Van Assche A, Vanderheyden S,
Wilmer A, Van den Berghe G. Early versus late parenteral nutrition in critically ill adults. New Engl J med 2011;
365: 506-17
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