title: Parenteral or enteral nutrition: do you have the choice?
abstract: The review focuses on the use of parenteral nutrition and enteral nutrition in critically ill patients to optimize the nutrition care throughout the ICU stay. The key message is: you have the choice!
  
  
  
  Enteral nutrition has been recommended for critically ill patients, whereas parenteral nutrition has been considered harmful and to be avoided. However, recent studies have challenged this theory. They demonstrated that enteral nutrition is frequently associated with energy and protein undernutrition, whereas parenteral nutrition becomes deleterious only if overfeeding is induced. Measuring energy expenditure by indirect calorimetry, in most cases, enables accurate determination of the energy needs to optimize the prescription of nutrition. Protein targets should also be considered for adequate feeding. Parenteral nutrition can be used as a supplement or as an alternative to enteral nutrition in case of gastrointestinal intolerance, to enable adequate energy, and protein provision.
  
  
  
  Parenteral nutrition is a powerful tool to optimize nutrition care of critically ill patients to improve clinical outcome, if prescribed according to the individual needs of the patients. After 3-4 days of attempt to feed enterally, enteral nutrition or parenteral nutrition can be used alternatively or combined, as long as the target is reached with special attention to avoid hypercaloric feeding.
authors.affiliation: aDepartment of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba City, Japan bCritical Care Medicine, Institute for Nutrition Research, Rabin Medical Center, Beilison Hospital, Petah Tikva, Israel cNutrition Unit, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Taku
authors.initials: T
authors.lastname: Oshima
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
authors.forename: Claude
authors.initials: C
authors.lastname: Pichard
mesh_terms: D002153:Calorimetry, Indirect; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004734:Energy Metabolism; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D010288:Parenteral Nutrition / Q000379:methods*; D016896:Treatment Outcome