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May 22, 2013

Early Nutrition in Critically Ill Patients: Feed Carefully and in Moderation

Author Affiliations

Author Affiliations: University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Ochoa); Anesthesiology, Pain, and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil (Dr Machado); and Nestlé Health Care Nutrition, Nestlé Health Science North America, Florham Park, New Jersey (Dr Ochoa).

JAMA. 2013;309(20):2165-2166. doi:10.1001/jama.2013.4867

Clinicians in intensive care units (ICUs) have to decide whether supplemental parenteral nutrition should be ordered for a critically ill patient who cannot be fed and is kept “nil per os (NPO),” for instance, because of gastrointestinal tract dysfunction. Without early supplemental parenteral nutrition, the patient is temporarily starved, an approach based on the assumption that physiologic compensatory processes are protective and thus there will be no untoward clinical consequences. In contrast, clinicians who order early supplemental parenteral nutrition presumably consider the accumulating caloric deficit to be deleterious for critically ill patients. Although determining the best approach might seem straightforward, a clear answer remains evasive.1,2