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Contemporary Rationale for Delivering Enteral Nutrition in Critically Ill Adults.

Jayshil J Patel¹, Robert G Martindale², Stephen A McClave³

¹Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI.

Critical Care Medicine

|May 21, 2025

Summary

Restrictive enteral nutrition in the acute phase of critical illness is recommended. High-dose protein is not superior and may harm critically ill adults, especially those with acute kidney injury.

Keywords:

critical care enteral nutrition gut dysfunction mechanical ventilation refeeding syndrome sarcopenia

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Area of Science:

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

Background:

Early enteral nutrition is a cornerstone in managing critically ill adults.
Guidelines historically recommended full enteral nutrition within 72 hours of ICU admission.

Purpose of the Study:

To review the rationale, timing, dosage, and monitoring of enteral nutrition and protein delivery in critically ill adults.
To synthesize evidence on optimal nutrition strategies during different phases of critical illness.

Main Methods:

Systematic searches of Medline for relevant studies, systematic reviews, meta-analyses, and guidelines.
Analysis of preclinical and contemporary clinical literature.

Main Results:

Restrictive enteral nutrition during the acute phase preserves gut integrity, supports the microbiome, and modulates immune dysregulation.
Full-dose enteral nutrition may lead to worse outcomes compared to restrictive doses.
High-dose protein does not improve outcomes and may be harmful in certain critically ill patients.

Conclusions:

Contemporary evidence supports restrictive enteral nutrition in the acute phase of critical illness.
High-dose protein is not superior to standard doses and is associated with adverse outcomes in specific patient groups, including those with acute kidney injury.