ASPEN Guidelines on Enteral nutrition in the ICU

These are the ASPEN guidelines on enteral nutrition that were published in 2016. They were created to assist us in providing patients with appropriate enteral nutrition while they recover from critical illness. This paper is free and although the 53 pages seem intimidating, the last 11 pages are the references. Also, the font is large and the format is easy to digest as it is laid out in a question/answer type format. I honestly look forward to the updated guidelines but these have a bunch of goodies that I do not feel the vast majority of my colleagues are aware of. I must admit, the majority of the recommendations are based on consensus rather than solid data. If that’s what we have, though, we must make do while asking healthy questions.

Fun facts I’ve picked up on re-reading these ASPEN guidelines on enteral nutrition that I had missed out on previous reads and that I may or may not have known:
– clear liquid diet is not necessary after post-op. Patients can be provided with solid food.
– patients should be getting 1.2-2.0g/kg of body weight of protein/ day. Some standard tube feeds may not reach this target in certain patients.
– I knew this but it begs reminding: DO NOT CHECK RESIDUALS!
– fancy formulas may be more confusing that practical for a standard patient in the MICU at the time of this publication.
– they made no recommendations for probiotics but I have found data stating otherwise.
– don’t bother with high-fat low carb formulations for reps failure
– check phosphorus levels regularly in respiratory failure patients. That was you can replace the K with K/Phos instead of compartmentalizing the electrolytes.
A 🎩 tip to the many contributors to this guideline.

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McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA, Gervasio JM, Sacks GS, Roberts PR, Compher C; Society of Critical Care Medicine; American Society for Parenteral and Enteral Nutrition. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016 Feb;40(2):159-211. doi: 10.1177/0148607115621863. Erratum in: JPEN J Parenter Enteral Nutr. 2016 Nov;40(8):1200. PMID: 26773077.
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