title: The intensive care medicine research agenda in nutrition and metabolism.
abstract: OBJECTIVE
  The objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years.
  
  
  METHODS
  Recent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism. Then, members of the panel rated each one of the topics using a grading system (0-4). Potential studies were ranked on the basis of average score.
  
  
  RESULTS
  Recent randomized controlled trials (RCTs) have challenged several concepts, including the notion that energy expenditure must be met universally in all critically ill patients during the acute phase of critical illness, the routine monitoring of gastric residual volume, and the value of immune-modulating nutrition. The optimal protein dose combined with standardized active and passive mobilization during the acute phase and post-acute phase of critical illness were the top ranked studies for the next 10 years. Nutritional assessment, nutritional strategies in critically obese patients, and the effects of continuous versus intermittent enteral nutrition were also among the highest-ranking studies.
  
  
  CONCLUSIONS
  Priorities for clinical research in the field of nutritional management of critically ill patients were suggested, with the prospect that different nutritional interventions targeted to the appropriate patient population will be examined for their effect on facilitating recovery and improving survival in adequately powered and properly designed studies, probably in conjunction with physical activity.
authors.affiliation: Intensive Care Department, MC 1425, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. arabi@ngha.med.sa.
authors.forename: Yaseen M
authors.identifier: http://orcid.org/0000-0001-5735-6241
authors.initials: YM
authors.lastname: Arabi
authors.affiliation: Laboratory and Clinical Department of Intensive Care Medicine, Catholic University Leuven, Leuven, Belgium.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Casaer
authors.affiliation: Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia.
authors.forename: Marianne
authors.initials: M
authors.lastname: Chapman
authors.affiliation: Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.affiliation: Anesthesiology and Intensive Care Medicine, Intensive Care Unit, Pasteur 2 Hospital, University Hospital of Nice, Nice, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Ichai
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Marik
authors.affiliation: Division of General and Gastrointestinal Surgery, Hospital Nutrition Services, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Martindale
authors.affiliation: Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McClave
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Preiser
authors.affiliation: Université de Nantes, Nantes, France.|CHU de Nantes, Service de Médecine Intensive Réanimation, Nantes, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Reignier
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Rice
authors.affiliation: Laboratory and Clinical Department of Intensive Care Medicine, Catholic University Leuven, Leuven, Belgium.
authors.forename: Greet
authors.initials: G
authors.lastname: Van den Berghe
authors.affiliation: Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan, Ede, The Netherlands.
authors.forename: Arthur R H
authors.initials: ARH
authors.lastname: van Zanten
authors.affiliation: Nutrition and Dietetics, Department of Internal Medicine, and Department of Intensive Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.|Department of Nutrition and Dietetics, School of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
authors.forename: Peter J M
authors.initials: PJM
authors.lastname: Weijs
mesh_terms: D035843:Biomedical Research; D001786:Blood Glucose / Q000378:metabolism; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy; D004040:Dietary Carbohydrates / Q000378:metabolism; D004044:Dietary Proteins / Q000378:metabolism; D004734:Energy Metabolism; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D015596:Nutrition Assessment; D009765:Obesity / Q000628:therapy; D010288:Parenteral Nutrition / Q000379:methods*; D016032:Randomized Controlled Trials as Topic
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004044:Dietary Proteins
keywords: Calorie; Critical care; Intensive care; Metabolism; Nutrition; Protein