title: Critical care nutrition support research:  lessons learned from recent trials.
abstract: OBJECTIVE
  In the past year, there have been a few large-scale trials of nutrition support in the critical care setting that have produced negative results and have challenged certain assumptions. The purpose of this study is to review those current trials and illustrate key methodological points that should help with the interpretation of these trials, and inform the design of critical care nutrition trials of artificial nutrition in the future.
  
  
  RESULTS
  Many recent and historical randomized trials of nutrition support in the ICU setting fail to consider which patients may benefit the most from artificial nutrition support (nutrition risk assessment) and longer-term outcomes such as return to physical function and health-related quality of life.
  
  
  CONCLUSIONS
  Future trials of nutrition support in the ICU, such as the TOP UP study, should include only 'high-risk' patients and should evaluate a broader range of outcomes than traditional ICU outcomes (28-day mortality, ventilator-free days, organ failure-free days, etc.). In the meantime, efforts to improve delivery of energy and protein to critically ill patients, such as with the enhanced protein-energy provision via the enteral route feeding protocol, are warranted.
authors.affiliation: Department of Medicine, Queen's University, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D003422:Critical Care / Q000379:methods*; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology; D007362:Intensive Care Units; D015596:Nutrition Assessment; D009752:Nutritional Status; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment
chemical_list: D004044:Dietary Proteins