Nutrition in critically ill patients: where do we stand?

Area of Science:

• Critical care medicine
• Clinical nutrition
• Intensive care unit (ICU) management

Background:

• Optimal nutritional support for critically ill patients is a significant clinical question.
• Recent large-scale randomized trials offer new insights into nutrition delivery routes and caloric intake.

Purpose of the Study:

• To analyze findings from the CALORIES and PermiT studies regarding nutrition in critically ill patients.
• To provide practical recommendations for nutritional management based on recent evidence.

Main Methods:

• The CALORIES study compared parenteral nutrition to enteral nutrition in 2388 critically ill adults.
• The PermiT study compared permissive underfeeding (40-60% of energy expenditure) to standard feeding (70-100%) in 894 enterally fed patients.

Main Results:

• CALORIES: Similar 30-day mortality; parenteral nutrition showed less hypoglycemia and vomiting.
• PermiT: Similar 90-day mortality; no significant differences in feeding intolerance or infections.
• Both studies indicate comparable outcomes between the tested nutritional strategies.

Conclusions:

• Early nutritional support routes (parenteral vs. enteral) do not significantly impact mortality in critically ill adults.
• Restrictive caloric intake (permissive underfeeding) versus standard feeding shows similar mortality and tolerance.
• These findings support nuanced approaches to nutrition in critical care, considering patient specifics.