title: ESPEN Guidelines on Parenteral Nutrition: intensive care.
abstract: Nutritional support in the intensive care setting represents a challenge but it is fortunate that its delivery and monitoring can be followed closely. Enteral feeding guidelines have shown the evidence in favor of early delivery and the efficacy of use of the gastrointestinal tract. Parenteral nutrition (PN) represents an alternative or additional approach when other routes are not succeeding (not necessarily having failed completely) or when it is not possible or would be unsafe to use other routes. The main goal of PN is to deliver a nutrient mixture closely related to requirements safely and to avoid complications. This nutritional approach has been a subject of debate over the past decades. PN carries the considerable risk of overfeeding which can be as deleterious as underfeeding. Therefore the authors will present not only the evidence available regarding the indications for PN, its implementation, the energy required, its possible complementary use with enteral nutrition, but also the relative importance of the macro- and micronutrients in the formula proposed for the critically ill patient. Data on long-term survival (expressed as 6 month survival) will also be considered a relevant outcome measure. Since there is a wide range of interpretations regarding the content of PN and great diversity in its practice, our guidance will necessarily reflect these different views. The papers available are very heterogeneous in quality and methodology (amount of calories, nutrients, proportion of nutrients, patients, etc.) and the different meta-analyses have not always taken this into account. Use of exclusive PN or complementary PN can lead to confusion, calorie targets are rarely achieved, and different nutrients continue to be used in different proportions. The present guidelines are the result of the analysis of the available literature, and acknowledging these limitations, our recommendations are intentionally largely expressed as expert opinions.
authors.affiliation: General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Tikva, Israel.
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
authors.forename: Greet
authors.initials: G
authors.lastname: Van den Berghe
authors.forename: Gianni
authors.initials: G
authors.lastname: Biolo
authors.forename: Philip
authors.initials: P
authors.lastname: Calder
authors.forename: Alastair
authors.initials: A
authors.lastname: Forbes
authors.forename: Richard
authors.initials: R
authors.lastname: Griffiths
authors.forename: Georg
authors.initials: G
authors.lastname: Kreyman
authors.forename: Xavier
authors.initials: X
authors.lastname: Leverve
authors.forename: Claude
authors.initials: C
authors.lastname: Pichard
authors.lastname: ESPEN
mesh_terms: D000328:Adult; D000075202:Contraindications; D003422:Critical Care / Q000592:standards; D004750:Enteral Nutrition; D019317:Evidence-Based Medicine; D006801:Humans; D044342:Malnutrition / Q000628:therapy*; D008875:Middle Aged; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult