• Jan Wernerman, Kenneth B Christopher, Djillali Annane, Michael P Casaer, Craig M Coopersmith, Adam M Deane, Elisabeth De Waele, Gunnar Elke, Carole Ichai, Constantine J Karvellas, Stephen A McClave, Oudemans-van Straaten Heleen M HM Department of Intensive Care, Amsterdam UMC, VU University, Amsterdam, Netherlands., Olav Rooyackers, Renee D Stapleton, Jukka Takala, van Zanten Arthur R H ARH Department of Intensive Care Medicine, Gelderse Vallei Hospital, 6716 RP, Ede, Netherlands., Paul E Wischmeyer, Jean-Charles Preiser, and Jean-Louis Vincent.
• Department of Anaesthesia and Intensive Care Medicine, Karolinska Institutet, 14186, Stockholm, Sweden.
• Crit Care. 2019 Sep 18; 23 (1): 318.

AbstractMetabolic alterations in the critically ill have been studied for more than a century, but the heterogeneity of the critically ill patient population, the varying duration and severity of the acute phase of illness, and the many confounding factors have hindered progress in the field. These factors may explain why management of metabolic alterations and related conditions in critically ill patients has for many years been guided by recommendations based essentially on expert opinion. Over the last decade, a number of randomized controlled trials have been conducted, providing us with important population-level evidence that refutes several longstanding paradigms. However, between-patient variation means there is still substantial uncertainty when translating population-level evidence to individuals. A cornerstone of metabolic care is nutrition, for which there is a multifold of published guidelines that agree on many issues but disagree on others. Using a series of nine questions, we provide a review of the latest data in this field and a background to promote efforts to address the need for international consistency in recommendations related to the metabolic care of the critically ill patient. Our purpose is not to replace existing guidelines, but to comment on differences and add perspective.

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