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Jayshil J. Patel

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Review Jul 2026

Nutrition Therapy in Critically Ill Adults.

In the acute phase of critical illness, adults have severe catabolism, inflammation, muscle loss, and gut dysfunction, all of which shape nutritional requirements. Early enteral nutrition supports gut integrity and microbiome health, but trials have shown that early short-term parenteral nutrition is a safe alternative when enteral feeding is not possible. Large trials have shown that early full-dose energy delivery offers no benefit over restrictive dosing and may increase gastrointestinal and metabolic complications, findings that support a restrictive nutrition strategy, especially in patients who have circulatory shock or are at risk for refeeding syndrome. Similarly, large trials have shown no advantage of high-dose over standard-dose protein and suggest harm in patients with acute kidney injury. Because adverse events are common with enteral nutrition, safe nutrition delivery requires gradual advancement, strategies for prevention of refeeding syndrome, glycemic control, and avoidance of routine gastric residual volume monitoring. Patient heterogeneity underscores the need for precise, biomarker-guided, phase-specific nutrition to preserve lean muscle mass and improve recovery.

Jayshil J. Patel, Stephen A McClave · 0 citations
Review Aug 2026

Providing appropriate response-contingent phase-specific nutrition therapy in critical illness.

PURPOSE OF REVIEW The pathogenesis of critical illness drives a dynamic cascade of clinical, metabolic, and immunologic abnormalities through the course of disease. Recent randomized trials show that early full-dose feeding for critically ill patients is ineffective and potentially harmful compared to trophic feeding. The aim of this review is to propose a response-contingent phase-specific strategy of nutrition therapy appropriate for this patient population. RECENT FINDINGS Barriers to delivering effective nutritional therapy exist, ranging from bioenergetic failure related to mitochondrial dysfunction and gastrointestinal dysmotility with feeding intolerance, to microbial dysbiosis and impaired substrate utilization characterized by inefficient energy production and futile substrate cycling. Emerging concepts are helping to design more appropriate regimens, including estimation of potential benefit from nutritional therapy based on disease severity, risk of net harm, and determination of the stage of enteral nutrition responsiveness, which can be conceptualized as the capacity for achieving phase-specific goals within the constraints of physiologic state, metabolic capacity, safety, and feasibility. SUMMARY Calibrating goals, dosage, monitoring strategies, and expectations from nutritional therapy is required to overcome barriers imposed by the underlying pathophysiology and to optimize support, as these complex patients transition through the acute phase of critical illness towards recovery and rehabilitation.

Stephen A McClave, R. Martindale, Jayshil J. Patel · 0 citations