Mixed
Early aggressive provision of full caloric and protein targets in critically ill patients provides no clinical benefit and may cause harm, whereas permissive underfeeding (restricted feeding) during the acute phase reduces ICU-acquired weakness and improves outcomes.
In the first week of critical illness, do not aim to meet full caloric or protein targets. Instead, use a 'permissive underfeeding' strategy. This approach has been shown to reduce muscle weakness and improve recovery compared to aggressive feeding. Focus on safety and tolerance rather than hitting specific calorie numbers immediately.
a number of trials in general ICU patients and in selected populations... show that restricted feeding strategies described as 'permissive or trophic' during the early phase of critical illness result in similar outcomes compared with standard caloric intake... tolerating a substantial macronutrient deficit during the first week of critical illness reduced ICU-acquired weakness (ICU-AW).
Why this rating
Supported by multiple RCTs (EPaNIC, PEPaNIC, CALORIES) and meta-analyses, though heterogeneity exists.
Source
The intensive care medicine research agenda in nutrition and metabolism
Yaseen M. Arabi et al. · Intensive Care Medicine · 2017
DOI 10.1007/s00134-017-4711-6
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