ESPEN ICU Nutrition 2023 — ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit

When oral intake is not possible, start enteral nutrition early (generally within 48 hours) when the gastrointestinal tract can be used, and prefer EN over routine early PN. Use indirect calorimetry to estimate energy expenditure in mechanically ventilated patients when feasible. Avoid full early feeding: if predictive equations are used, provide hypocaloric nutrition (<70% of estimated needs) during the early acute phase and increase progressively after the first several days; when energy expenditure is measured, advance toward measured needs as clinical stability improves. Protein provision should be progressive and individualized; approximately 1.3 g/kg/day is suggested, while recent randomized trials do not support routine very-high early protein dosing.