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Nutritional support for critically ill patients by the Korean Society for Parenteral and Enteral Nutrition—part II: a clinical practice guideline
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Jae Gil Lee
 , You Min Sohn, Seung Hwan Lee, Yun Tae Jung, Hak-Jae Lee, Jeong Yun Park, Nak-Jun Choi, Jung Mi Song, Jee Young Lee, Ji Yeon Kim, Ji Yeong Jeong, Ye Won Sung, Eun Jeong Park, Hyun Ji Ko, Ji Yoon Cho, Bomi Kim, Yesung Oh, In Chung Lee, Jin Young Lee, A Ram Kim, Jee Yeon Lee, Seong-Eun Kim, Tae Sun Ha, Min Kwan Kwon
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Ann Clin Nutr Metab 2026;18(2):65-116. Published online July 31, 2026
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DOI: https://doi.org/10.15747/ACNM.26.0059
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 Abstract
 PDF Supplementary Material
- Purpose
Nutritional therapy is an essential component of intensive care management. Appropriate nutritional support may reduce infectious and metabolic complications and promote recovery in critically ill patients. However, nutritional practices vary across institutions, and international guidelines may not be directly applicable to clinical practice in Korea. Evidence-based clinical practice guidelines that reflect Korean intensive care unit practice are therefore needed.
Methods
The Korean Society for Parenteral and Enteral Nutrition developed these clinical practice guidelines for nutritional therapy in critically ill adults through a systematic literature review and multidisciplinary expert consensus.
Results
In total, 24 key clinical questions and 59 recommendations were developed. The guidelines address enteral and parenteral nutrition, feeding intolerance, aspiration prevention, energy and protein assessment, immune-modulating nutrition, micronutrient supplementation, refeeding syndrome, and disease-specific nutritional therapy for critically ill adults, including those with acute kidney injury, acute liver failure, acute respiratory distress syndrome, sepsis, trauma, and obesity. The recommendations emphasize individualized nutritional therapy according to hemodynamic status, metabolic phase, organ dysfunction, nutritional risk, and treatment goals.
Conclusion
These guidelines provide practical, evidence-based recommendations for nutritional therapy in critically ill adults and reflect both current international evidence and Korean clinical practice. They may support more standardized and consistent nutritional support in Korean intensive care units.
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Nutritional support for critically ill patients by the Korean Society for Parenteral and Enteral Nutrition — part I: a clinical practice guideline
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Seung Hwan Lee, Jae Gil Lee, Min Kwan Kwon, Jiyeon Kim, Mina Kim, Jeongyun Park, Jee Young Lee, Ye Won Sung, Bomi Kim, Seong Eun Kim, Ji Yoon Cho, A Young Lim, In Gyu Kwon, Miyoung Choi, KSPEN Guideline Committee
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Ann Clin Nutr Metab 2024;16(3):89-111. Published online December 1, 2024
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DOI: https://doi.org/10.15747/ACNM.2024.16.3.89
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Abstract
PDFSupplementary Material
- Purpose: Nutritional support for adult critically ill patients is essential due to the high risk of malnutrition, which can lead to severe complications. This paper aims to develop evidence-based guidelines to optimize nutritional support in intensive care units (ICUs).
Methods: The Grading Recommendations, Assessment, Development and Evaluation process was used to develop and summarize the evidence on which the recommendations were based. Clinical outcomes were assessed for seven key questions.
Results: We recommend the following: (1) initiate enteral nutrition (EN) within 48 hours after treatment as it is associated with improved outcomes, including reduced infection rates and shorter ICU stays; (2) early EN is preferred over early parenteral nutrition due to better clinical outcomes; (3) the use of supplementary parenteral nutrition to meet energy targets during the first week of ICU admission in patients receiving early EN is conditionally recommended based on patient-specific needs; (4) limited caloric support should be supplied to prevent overfeeding and related complications, particularly in the early phase of critical illness; (5) higher protein intake is suggested to improve clinical outcomes, such as muscle preservation and overall recovery; (6) additional enteral or parenteral glutamine is conditionally recommended against due to the lack of significant benefit and potential harm; and (7) fish oil-containing lipid emulsions is conditionally recommended due to their potential to enhance clinical outcomes, including reduced infection rates and shorter ICU stays.
Conclusion: These evidence-based recommendations can improve clinical outcomes and support healthcare providers in making informed decisions about nutritional interventions in the ICU.
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Citations
Citations to this article as recorded by  - Case Report: Optimizing wound care: tailored nutritional strategies with immune- modulating enteral nutrients
Fiji Antony, Wafaa Ayesh
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Current Opinion in Critical Care.2026;[Epub] CrossRef - Nutritional support for critically ill patients by the Korean Society for Parenteral and Enteral Nutrition—part II: a clinical practice guideline
Jae Gil Lee, You Min Sohn, Seung Hwan Lee, Yun Tae Jung, Hak-Jae Lee, Jeong Yun Park, Nak-Jun Choi, Jung Mi Song, Jee Young Lee, Ji Yeon Kim, Ji Yeong Jeong, Ye Won Sung, Eun Jeong Park, Hyun Ji Ko, Ji Yoon Cho, Bomi Kim, Yesung Oh, In Chung Lee, Jin Youn
Ann Clin Nutr Metab.2026; 18(2): 65. CrossRef - Enteral Nutrition Versus a Combination of Enteral and Parenteral Nutrition in Critically Ill Adult Patients in the Intensive Care Unit: An Overview of Systematic Reviews and Meta-Analysis
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Journal of Clinical Medicine.2025; 14(3): 991. CrossRef
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