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

Clinicians in intensive care units 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," 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. Here, Gautier et al comment on Doig and colleagues's report findings from a 5-year, multicenter, randomized clinical trial that sheds new light on this debate.