Recommendations Summary

CI: Nutrition Prescription for Critically Ill Adults 2012

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  CI: Nutrition Prescription for Critically Ill Adults

  The Registered Dietitian (RD) should develop a nutrition prescription for critically ill adults to include:

  • Energy
  • Protein
  • Fiber
  • Vitamins
  • Minerals
  • Fluid.

  Nutrition interventions are selected based on the nutrition prescription.

  Rating: Consensus
  Imperative

  • Risks/Harms of Implementing This Recommendation

    • Over- or underfeeding may lead to metabolic and clinical complications and subsequent poor outcomes
    • Provision of nutrition support, including enteral nutrition (EN) or parenteral nutrition (PN), to nutritionally compromised critically ill patients may be associated with patient complications including, but not limited to:
      • Aspiration
      • Infections, including catheter-related infections
      • Metabolic complications resulting from under- or overfeeding
      • Gastrointestinal (GI) complications, including diarrhea
      • Provision of excessive or inadequate fluid may lead to inappropriate hydration status and subsequent poor outcomes.

  • Conditions of Application

    The patient should be closely monitored for signs and symptoms of overfeeding or underfeeding, or of substrate overload.

  • Potential Costs Associated with Application

    Organizational expenses incurred as a result of treating critically ill patients may be reduced by the provision of adequate nutrition care.

  • Recommendation Narrative

    Consensus.

  • Recommendation Strength Rationale

    Consensus reached.

  • Minority Opinions

    None.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  • References
  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    Task Force of A.S.P.E.N; American Dietetic Association Dietitians in Nutrition Support Dietetic Practice Group, Russell M, Stieber M, Brantley S, Freeman AM, Lefton J, Malone AM, Roberts S, Skates J, Young LS; A.S.P.E.N. Board of Directors; ADA Quality Management Committee. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and American Dietetic Association (ADA): standards of practice and standards of professional performance for registered dietitians (generalist, specialty, and advanced) in nutrition support. Nutr Clin Pract. 2007 Oct; 22 (5): 558-586. PMID: 17906280.