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.)

Beth E. Taylor, RD, DCN; Stephen A. McClave, MD; Robert G. Martindale, MD, PhD; Malissa M. Warren, RD; Debbie R. Johnson, RN, MS; Carol Braunschweig, RD, PhD; Mary S. McCarthy, RN, PhD; Evangelia Davanos, PharmD; Todd W. Rice, MD, MSc; Gail A. Cresci, RD, PhD; Jane M. Gervasio, PharmD; Gordon S. Sacks, PharmD; Pamela R. Roberts, MD; Charlene Compher, RD, PhD


Crit Care Med. 2016;44(2):390-438. 

In This Article


The significance of nutrition in the hospital setting (and especially the ICU) cannot be overstated. Critical illness is typically associated with a catabolic stress state in which patients demonstrate a systemic inflammatory response coupled with complications of increased infectious morbidity, multiple organ dysfunction, prolonged hospitalization, and disproportionate mortality. Over the past three decades, exponential advances have been made in the understanding of the molecular and biological effects of nutrients in maintaining homeostasis in the critically ill population. Traditionally, nutrition support in the critically ill population was regarded as adjunctive care designed to provide exogenous fuels to preserve lean body mass and support the patient throughout the stress response. Recently this strategy has evolved to represent nutrition therapy, in which the feeding is thought to help attenuate the metabolic response to stress, prevent oxidative cellular injury, and favorably modulate immune responses. Improvement in the clinical course of critical illness may be achieved by early EN, appropriate macro- and micronutrient delivery, and meticulous glycemic control. Delivering early nutrition support therapy, primarily by the enteral route, is seen as a proactive therapeutic strategy that may reduce disease severity, diminish complications, decrease LOS in the ICU, and favorably impact patient outcomes.