Delivering nutritional support at the right time and in the right way: what have we learned over the last few decades?

Multiple shifts in perspectives regarding nutritional therapy have occurred over the years, with the publication of landmark papers and international guidelines providing a framework for the management of nutrition in the intensive care unit (ICU). The objective of this state-of-the-art review is to address the changes to critical care nutritional support over the past few decades.

A literature review was performed using electronic databases to search for papers and nutritional guidelines to provide a summary focusing specifically on recent advances over the past few decades regarding the correct timing of and personalized nutrition for critically ill patients using an evidence-based approach.

Current evidence suggests that early enteral nutrition and parenteral nutrition are equivalent in terms of outcomes if used exclusively. Parenteral nutrition is safer than previously believed; however, supplemental parenteral nutrition should be held for 7–10 days if the patient will not be able to take oral or enteral nutritional support for long periods of time. Enteral nutrition should be initiated within 24–48 h, preferably via a post-pyloric route if possible. Overfeeding and underfeeding have no benefit over normal caloric goals. Initiation of enteral nutrition in hemodynamic shock continues to be debated.

There have been changing perspectives regarding critical care nutrition over the past few decades. The Society of Critical Care Medicine (SCCM)/American Society of Parenteral and Enteral Nutrition (ASPEN)/European Society for Clinical Nutrition (ESPEN)/European Society of Intensive Care Medicine (ESICM) guidelines provide a framework for how critical care providers should manage nutrition in the critically ill, but there will be continued changes and updates to these guidelines as additional trials and studies are performed that provide new evidence.