title: Pragmatic approach to nutrition in the ICU: expert opinion regarding which calorie protein target.
abstract: OBJECTIVE
  Since the publications of the ESPEN guidelines on enteral and parenteral nutrition in ICU, numerous studies have added information to assist the nutritional management of critically ill patients regarding the recognition of the right population to feed, the energy-protein targeting, the route and the timing to start.
  
  
  METHODS
  We reviewed and discussed the literature related to nutrition in the ICU from 2006 until October 2013.
  
  
  RESULTS
  To identify safe, minimal and maximal amounts for the different nutrients and at the different stages of the acute illness is necessary. These amounts might be specific for different phases in the time course of the patient's illness. The best approach is to target the energy goal defined by indirect calorimetry. High protein intake (1.5 g/kg/d) is recommended during the early phase of the ICU stay, regardless of the simultaneous calorie intake. This recommendation can reduce catabolism. Later on, high protein intake remains recommended, likely combined with a sufficient amount of energy to avoid proteolysis.
  
  
  CONCLUSIONS
  Pragmatic recommendations are proposed to practically optimize nutritional therapy based on recent publications. However, on some issues, there is insufficient evidence to make expert recommendations.
authors.affiliation: General Intensive Care Department and Institute of Nutrition Research, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, Israel. Electronic address: psinger@clalit.org.il.
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
authors.affiliation: Department of Anaesthesia, General Intensive Care and Pain Control, Medical University Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Hiesmayr
authors.affiliation: Universita degli Studi di Trieste, Faculta di Medicina e Chirurgia, Strada di Fiume 447, Osp di Cattinara, 34149 Trieste, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Biolo
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, Neuperlach Medical Center, The Munich Municipal Hospital Ltd, Munich, Germany.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Felbinger
authors.affiliation: Service de Médecine Intensive Adulte & Brûlés CHUV, 1011 Lausanne, Switzerland.
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Goeters
authors.affiliation: Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Kondrup
authors.affiliation: Universitatsklinikum Wurzburg, Klinik und Poliklinik fur Anesthesiologie, Oberdurrbacher Str 6, 97080 Wurzburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wunder
authors.affiliation: Clinical Nutrition - Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
authors.forename: Claude
authors.initials: C
authors.lastname: Pichard
mesh_terms: D002153:Calorimetry, Indirect; D016638:Critical Illness / Q000628:therapy; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D006801:Humans; D007362:Intensive Care Units; D064887:Observational Studies as Topic; D010288:Parenteral Nutrition / Q000592:standards; D016032:Randomized Controlled Trials as Topic
chemical_list: D004044:Dietary Proteins
keywords: Calories; Energy; Enteral nutrition; Intensive care; Parenteral; Protein