The Japanese Critical Care Nutrition Guideline 2024

Area of Science:

• Critical Care Medicine
• Clinical Nutrition
• Evidence-Based Practice

Background:

• Nutrition therapy is crucial for critically ill patients, with evolving evidence necessitating updated guidelines.
• The Japanese Society of Intensive Care Medicine revised the 2016 guidelines to create the Japanese Critical Care Nutrition Guideline 2024 (JCCNG 2024).

Purpose of the Study:

• To provide healthcare professionals with updated, evidence-based recommendations for nutrition therapy in adult and pediatric intensive care units.
• To improve patient outcomes through standardized and effective nutrition management in critical care settings.

Main Methods:

• Development followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.
• Recommendations were finalized by consensus using the modified Delphi method among multidisciplinary experts.
• Guidelines address 37 clinical questions, including immunomodulation, special conditions, and pediatric nutrition.

Main Results:

• Strong recommendations for adults: early enteral nutrition (EN) within 48 hours and pre/synbiotics.
• Weak recommendations for adults: nutrition protocols, EN over parenteral nutrition, higher protein, post-pyloric EN, continuous EN, omega-3 enriched EN, probiotics, and indirect calorimetry.
• Weak recommendations for children: early EN within 48 hours, bolus EN, and energy/protein-dense formulas. Nutritional assessment is recommended for all patients.

Conclusions:

• The JCCNG 2024 provides comprehensive, GRADE-based recommendations for critical care nutrition.
• Dissemination will occur through educational activities, with planned revisions in 4-6 years based on global research.
• The guidelines aim to enhance clinical practice and guide future research in nutrition therapy for critically ill patients.