Nutrition Therapy in the ICU

Nutrition therapy in the intensive care unit requires a shift from passive support to active, phase-specific intervention. During the early acute phase of critical illness, the body’s profound metabolic stress response limits the ability to utilize nutrients, rendering aggressive, full-dose feeding counterproductive. Instead, clinicians should prioritize preserving gut integrity and microbiome function through trophic enteral nutrition, while reserving parenteral nutrition for cases where enteral access is contraindicated or unsafe. Evidence from major trials, including NUTRIREA-2 and the EFFRT protein study, demonstrates that high-dose caloric and protein delivery during this phase offers no mortality benefit and may increase complications like hyperglycemia and bowel ischemia. Effective management involves monitoring for nutrition responsiveness, abandoning routine gastric residual volume checks, and individualizing therapy based on the patient’s evolving hemodynamic status and metabolic capacity rather than adhering to rigid, one-size-fits-all protocols.