Critical Care Societies Collaborative – Critical Care

View all recommendations from this society

Released January 28, 2014

Don”t use parenteral nutrition in adequately nourished critically ill patients within the first seven days of an ICU stay.

For patients who are adequately nourished prior to ICU admission, parenteral nutrition initiated within the first seven days of an ICU stay has been associated with harm, or at best no benefit, in terms of survival and length of stay in the ICU. Early parenteral nutrition is also associated with unnecessary costs. These findings are true even among patients who cannot tolerate enteral nutrition. Evidence is mixed regarding the effects of early parenteral nutrition on nosocomial infections. For patients who are severely malnourished directly prior to their ICU admission, there may be benefits to earlier parenteral nutrition.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

This document was prepared as an initiative of the Critical Care Societies Collaborative, which includes the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society and the Society of Critical Care Medicine. Each of these four societies was invited to nominate up to three members to join the taskforce. The final taskforce included 10 members representing all four societies and the disciplines of internal medicine, surgery, anesthesiology, emergency medicine and critical care nursing. Taskforce members initially proposed 58 items for consideration. The taskforce evaluated each item on five criteria (evidence, prevalence, cost, relevance, innovation), and agreed to narrow the list to 16 items. The taskforce debated the conceptual merits of these 16, and selected nine in which to pursue in-depth evidence reviews and consultations with external content experts. Taskforce members then independently scored each item on a scale from 1-9, rating each item on its overall impact as well as on each of the five criteria. The five items with the best mean overall scores were retained in the “penultimate” list. The taskforce then reviewed and edited the wording of items on the penultimate list, and submitted it to the 4 societies’ executive committees. The executive committees sought feedback from additional experts in the field, debated the items, and provided written comments to the taskforce. The taskforce deliberated and incorporated these suggestions where appropriate to create the final list, resolving any conflicts through discussion. All four societies endorsed the final list.

Members of the taskforce were: Scott D. Halpern, MD, PhD (Chair), Deborah Becker, PhD, RN, J. Randall Curtis, MD, MPH, Robert Fowler, MD, Robert Hyzy, MD, Jeremy M. Kahn, MD, MSc, Lewis Kaplan, MD, Nishi Rawat, MD, Curtis Sessler, MD and Hannah Wunsch, MD, MSc.

The disclosure and conflict of interest policies for the American Association of Critical Care Nurses, American College of Chest Physicians, the American Thoracic Society and the Society of Critical Care Medicine can be found at www.accn.org, www.chestnet.org,www.thoracic.org and www.sccm.org respectively.

Sources

Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, Van Cromphaut S, Ingels C, Meersseman P, 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. N Eng J Med. 2011;365:506–17.

Heidegger CP, Berger MM, Graf S, Zingg W, Darmon P, Costanza MC, Thibault R, Pichard C. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013;381(9864):385–93.

Martindale RG, McClave SA, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G; American College of Critical Care Medicine; A.S.P.E.N. Board of Directors. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition: Executive Summary. Crit Care Med. 2009;37(5):1757–61.

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(4):387–400.

Buzby GP. Overview of randomized clinical trials of total parenteral nutrition for malnourished surgical patients. World JSurg 1993;17:173–7.