Early nutrition support in the intensive care unit: a US perspective.
OBJECTIVE
Early nutrition support, defined as within the first 24-48 h of ICU care, is recommended by clinical practice guidelines. The purpose of this paper is to provide an evidence-based US perspective on early nutrition support in critical illness, explain its mechanism of action, and describe its implementation using combined enteral and parenteral nutrition support.


RESULTS
Recent American and Canadian guidelines recommend starting enteral nutrition within the first 24-48 h of ICU care. This is mainly due to accrued 'energy debt' from underfeeding in certain patients. This energy debt leads to increased risks of complications and longer lengths of stay. Strong clinical evidence, however, in the form of prospective, randomized, controlled intervention studies of early nutrition support in the setting of routine intensive insulin therapy, is lacking.


CONCLUSIONS
Early enteral nutrition should be first-line therapy in the ICU. If a caloric goal of 20-25 kcal/kg/day is not possible, then combined enteral and parenteral nutrition should be started. In the new age of intensive insulin therapy, parenteral nutrition has not been shown to confer significant additional infective risk. There are many unanswered questions, but a proactive posture for metabolic support in the ICU is advocated.
Scurlock
Corey
C
Cardiothoracic Intensive Care Unit, Department of Anesthesiology and Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA. corey.scurlock@mountsinai.org
Mechanick
Jeffrey I
JI
D016638:Critical Illness / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units; D009751:Nutritional Requirements; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007328:Insulin