Energy balance
In adult critically ill patients, providing higher energy intake (up to 30 kcal/kg/day) compared to lower intake (down to 300 kcal/day) does not significantly improve clinical outcomes such as mortality, length of stay, or infection rates.
For critically ill adults in the ICU, aim for 12-25 kcal/kg/day during the first 7-10 days. Do not aggressively push for higher calories, as studies show no benefit over lower doses and potential risks like hyperglycemia. Monitor blood sugar and triglycerides closely.
No significant difference in clinical outcomes was found between patients with higher vs lower levels of energy intake. We suggest feeding between 12 and 25 kcal/kg (ie, the range of mean energy intakes examined) in the first 7–10 days of ICU stay.
Why this rating
Moderate quality evidence based on 13 RCTs, but limited by heterogeneity and lack of specific cut-points.
Source
Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition
Charlene Compher et al. · Journal of Parenteral and Enteral Nutrition · 2021
DOI 10.1002/jpen.2267
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- Initiating supplemental parenteral nutrition (SPN) within the first week of ICU admission provides no clinically important benefit compared to enteral nutrition (EN) alone.Good
- Providing similar energy intake via parenteral nutrition (PN) as compared to enteral nutrition (EN) in the first week of critical illness results in similar clinical outcomes.Good
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