Annals of Clinical Nutrition and Metabolism

Nutritional support for critically ill patients by the Korean Society for Parenteral and Enteral Nutrition — part I: a clinical practice guideline: 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; Ann Clin Nutr Metab 2024;16(3):89-111. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.89

Abstract PDF Supplementary 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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The 2024 Korean Enhanced Recovery After Surgery guidelines for colorectal cancer: Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park, The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition; Ann Clin Nutr Metab 2024;16(2):22-42. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.22

Abstract PDF Supplementary Material: The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition was established to develop ERAS guidelines tailored to the Korean context. This guideline focuses on creating the most current evidence-based practice guidelines for ERAS based on systematic reviews. All key questions targeted randomized controlled trials (RCTs) exclusively. If fewer than two RCTs were available, studies using propensity score matching were also included. Recommendations for each key question were marked with strength of recommendation and level of evidence following internal and external review processes by the committee.

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Current Guidelines on Clinical Nutrition in Intensive Care Units Based on ESPEN 2018: Ahron Lee, Eun-Mee Kim, Chimin Park, Mi-Young Rha; J Clin Nutr 2019;11(2):31-37. Published online December 31, 2019; DOI: https://doi.org/10.15747/jcn.2019.11.2.31

Abstract PDF: As the significance of nutrition in intensive care unit grows, large prospective randomized controlled trials on nutrition therapy have been performed and recently published. Each society for Parenteral and Enteral Nutrition designated recommendations for clinical practice based on the best available evidence and the consensus of experts. The European Society for Parenteral and Enteral Nutrition (ESPEN) has released a new guideline that has been updated from the previous ESPEN guidelines on enteral nutrition and parenteral nutrition in adult critically ill patients published in 2006 and 2009, respectively. This study examined the latest trends of nutrition guidelines, and especially those of the ESPEN 2018, for intensive care units as compared to guidelines of other societies and older previous guidelines.

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Current Trend of Nutritional Support Treatment Guidelines for Critically Ill Patients: Yoo Jin Choi, Jae-Myeong Lee; J Clin Nutr 2017;9(2):38-47. Published online December 31, 2017; DOI: https://doi.org/10.15747/jcn.2017.9.2.38

Abstract PDF: Critically ill and injured patients admitted in the intensive care unit have a range of diseases with various severities. Their conditions should be assessed and the patients should receive specialized nutrition therapy depending on their condition. Like general intensive care, nutrition therapy is upgraded every few years with revised information to provide more idealized nutrition support. The main guidelines in this review are from the Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Their previous 2009 guidelines were revised and published in 2016. This review summarizes the 2016 SCCM/ASPEN guidelines focusing on the changes from the previous 2009 guidelines.

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Changes in 2015 Canadian Clinical Practice Guidelines: Dae-Sang Lee; J Clin Nutr 2015;7(3):70-74. Published online December 31, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.3.70

Abstract PDF: Careful nutritional strategy is an essential component in the management of critically ill patients. Evidence-based clinical practice guidelines can be an effective solution to improving the process and structure of nutritional strategy for critically ill patients. The 2015 Canadian clinical practice guidelines (CPGs) summarized the evidence from approximately 354 randomized controlled trials in the area of critical care nutrition since 1980. The Canadian CPGs were first developed in 2003 and have been updated every 2 years. It is important for the acquisition of new evidence-based knowledge. This paper includes a brief summary on changes in 2015 CPGs compared with 2013 CPGs.

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The Current Status of Enteral Feeding Management in General Surgical Ward: Yun Jung Kim, Young Mee Baek, So Yun Kim, Mi Reu Moon, Kyung Hee Park, So Hee Paeck, Moon Young Seo, Sook Young Oh, Eun Ji Lee, Hyun Bin Lim, Ji Ye Hwang, In Sun Chung, Jae Kil Lee, Kyung Sik Kim, Chong Bai Kim; J Clin Nutr 2015;7(1):23-27. Published online April 30, 2015; DOI: https://doi.org/10.15747/jcn.2015.7.1.23

Abstract PDF: Purpose:
Development of a standardized guideline and assessment tool is necessary. Therefore, the aim is to investigate the current state of enteral feeding management and to develop a basis for a standardized guideline.
Methods:
From July 1, 2010 through June 30, 2011, this study was conducted retrospectively for 100 patients who had enteral feeding more than once only in the Intensive Care Unit, after General Surgery at Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. The analysis was based on the following factors; age, diagnosis, name of the operation, period of start and the end of enteral feeding, method of injection, flushing method, residual volumes of the stomach, location and the size of the tube, medication through tubing, and complications related to enteral feeding.
Results:
The mean age of the patients was 60.5, 65 men and 35 women. There were 30 malignant tumors of the hepatobiliary system and pancreas, 8 gastric and duodenal cancer, 4 colon and rectal cancer, 11 peritonitis, hemoperitoneum, and bowel obstruction, and 47 others. The average period of performing enteral feeding was 11.7 days and the locations of enteral feeding tube were stomach 56%, jejunum 39%, duodenum 3%, and undescribed 2%. The methods of enteral feeding were as follows; continuous feeding 19%, cyclic feeding 75%, intermittent and bolus feeding 3%, respectively. Only 1% of patients were on flushing and 16% on stomach residual. The most common complication of enteral feeding was clogging of the tube (5%).
Conclusion:
Due to the lack of detailed charting related to enteral feeding, we were unable to analyze the statistics on the relevance of complication which was the primary endpoint. As a result, development of a standardized protocol on charting enteral feeding is suggested for optimal enteral nutritional support.

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