Exploration of and Application to Practice: Guidelines for the
Provision and Assessment of Nutrition Support Therapy in the Adult Critically
Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for
Parenteral and Enteral Nutrition (ASPEN)
The significance of nutrition in the hospital setting (especially the ICU)
cannot be overstated. Critical illness is typically associated with a catabolic
stress state in which patients demonstrate a systemic inflammatory response
coupled with complications of increased infectious morbidity, multiple-organ
dysfunction, prolonged hospitalization, and disproportionate mortality. Over
the past 3 decades, exponential advances have been made in the understanding of
the molecular and biological effects of nutrients in maintaining homeostasis in
the critically ill population. Traditionally, nutrition support in the
critically ill population was regarded as adjunctive care designed to provide
exogenous fuels to preserve lean body mass and support the patient throughout
the stress response. Recently, this strategy has evolved to represent nutrition
therapy, in which the feeding is thought to help attenuate the metabolic
response to stress, prevent oxidative cellular injury, and favorably modulate
immune responses. Improvement in the clinical course of critical illness may be
achieved by early EN, appropriate macro- and micronutrient delivery, and
meticulous glycemic control. Delivering early nutrition support therapy,
primarily by the enteral route, is seen as a proactive therapeutic strategy
that may reduce disease severity, diminish complications, decrease LOS in the
ICU, and favorably impact patient outcomes.
Guidelines for the Provision and Assessment of Nutrition Support
Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine
(SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN)
Stephen A. McClave, MD*; Beth E. Taylor, RD, DCN*; Robert G. Martindale, MD,
PhD; Malissa M. Warren, RD; Debbie R. Johnson, RN, MS; Carol Braunschweig, RD,
PhD; Mary S. McCarthy, RN, PhD; Evangelia Davanos, PharmD; Todd W. Rice, MD,
MSc; Gail A. Cresci, RD, PhD; Jane M. Gervasio, PharmD; Gordon S. Sacks,
PharmD; Pamela R. Roberts, MD; Charlene Compher, RD, PhD; and the Society of
Critical Care Medicine† and the American Society for Parenteral and Enteral
Nutrition†. JPEN J Parenter Enteral Nutr published online 15 January 2016.
*Beth Taylor and Steven McClave are co–first authors of this article.
†ASPEN and SCCM are co-last authors.
In response to these recently released guidelines, ASPEN hosted a live
training course featuring three of the experts who contributed to the
guidelines to educate all members of the healthcare team who work in the
critical care setting. Recordings of
this course are now available as an on demand learning opportunity and includes
an exploration of the guidelines and then allows for an in- depth assessment of
how the guidelines should be implemented into practice for the provision of
optimal nutrition care of the adult critically ill patient.
Goal and Target Audience
CE activity serves to promote the process
of life-long learning for physicians, dietitians, pharmacists, and nurses who
specialize in the sciences of clinical nutrition and metabolism in the critical
1. Discuss the strengths and weaknesses regarding the quality of the evidence for development of the guidelines.
2. Describe the concept of nutritional risk.
3. Summarize new supporting literature that reinforces practice concepts that are unchanged from the 2009 guidelines.
4. Discuss new supporting literature that has modified or changed the recommendations from the 2009 guidelines including expanded recommendations for specialized areas of practice (e.g., pancreatitis, trauma, burns, sepsis, post-operative, chronic critically ill, obesity).
5. Utilize the guidelines to guide clinical decisions in a variety of complex patient cases.
Robert G. Martindale, MD, PhD, Chief, Division of General Surgery; Medical Director, Hospital Nutritional Services, Oregon Health and Science University, Portland, OR
Stephen A. McClave, MD, FASPEN, Professor of Medicine, Division of Gastroenterology/ Hepatology, University of Louisville School of Medicine, Louisville, KY
Beth Taylor, DCN, RD, LD, CNSC, Nutrition Support Specialist, Surgical ICU, Barnes-Jewish Hospital, St. Louis, MO
Accreditation and Continuing Education Information
Course Details and Target
This course is intended for all healthcare professionals who provide nutrition
therapy to critically-ill adult patients – with an emphasis on physicians,
nurses, dietitians and pharmacists.
Course Practice Gap and Goal
With newly release guidelines for the provision of nutrition therapy in the
critically ill patient population healthcare providers need to be adequately
trained on best practices to fully implement the guidelines into practice. The
goal of his course is to train healthcare professionals to adequately assess
critically ill patients and subsequently provide adequate nutrition therapy to
aid with recovery from the illness.
To obtain CE credit for this
activity, attendees must listen to the education recording, complete an online
knowledge assessment for each education recording and achieve a score of 100%,
and complete an online activity evaluation. All CE credit must be claimed prior
to the expiration date. Note:
successfully completing the posttest is required for nurses,
pharmacists, and physicians, not dietitians.
Dietitians may claim credit for viewing/listening to the recording per
Nurses, Pharmacists, Physicians
Society for Parenteral and Enteral Nutrition (ASPEN) is accredited by the
American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy
Education (ACPE), and the Accreditation Council for Continuing Medical
Education (ACCME), to provide continuing education for the healthcare team.
designates this enduring/on demand activity for a maximum of 4.5 contact hours (0.45 CEU). Knowledge
designates this enduring material for a maximum of 4.5 AMA PRA Category 1 Credits TM
per activity. Physicians should only claim credit commensurate with the extent
of their participation in the activity.
approved by the California Board of Registered Nursing, Provider CEP 3970.
ACPE UAN: 0216-0000-16-136-H01-P
Provider Number AM005, is a Continuing Professional Education (CPE) Accredited Provider with the Commission on
Dietetic Registration (CDR). Registered
dietitians (RDs) will receive continuing professional education units (CPEUs)
for completion of this program / materials.CDR level 2 for 4.5 CPEUs. Dietitians may post comments on this program
grievances should be addressed in writing to Director of Education and
Research ASPEN 8630 Fenton Street Suite 412 Silver Spring, MD 20910.
ASPEN subscribes to the ACCME Standards for Commercial Support. ASPEN does
not provide programs that constitute advertisement or include promotional
content. ASPEN does not endorse any products. There will be no discussion
of off-label use of products.
and Confidentiality: ASPEN respects the privacy of its members and website
visitors. Companies that receive personal information from ASPEN in order
to execute the business of ASPEN may use personal information only for
Policy: Refunds are not available for the on demand activity.
Computer Requirements and Technical
will need a computer with internet connection and it is recommended that end
users' devices satisfy the following requirements:
- OS: Windows, Mac
- Browser: Internet Explorer 7 or
higher, Firefox, Chrome, Safari
- Adobe Flash Player 9.124.0 or
- Recommended RAM: 512MB+
- Apple iPad/iPhone running HTML5
- Android Device running Flash
For technical difficulties please contact Digitell
Inc. Customer Support at: 1-800-679-3646
Office hours are between 9AM to 5PM ET, Monday
Confidentiality: ASPEN respects the privacy of
its members and website visitors. Companies that receive personal information
from ASPEN in order to execute the business of ASPEN may use personal
information only for that purpose.
In relation to the course being presented, the faculty have the following
commercial relationship disclosures and conflicts of interest to report.
Martindale: while not related to the course content, Dr. Martindale has
worked with several commercial entities as listed below. All information
presented by Dr. Martindale will be evidence-based. Grant from
Metagenics, Consulting fee from Abbott and Nestle
McClave: while not related to the course content, Dr. McClave has worked
with several commercial entities as listed below. All information
presented by Dr. McClave will be evidence-based. Nestle, Metagenics,
and Abbott as a member of their speaker’s bureau, and consultant for
Metagenics and Covidien. Receives honoraria
Taylor: nothing to disclose
Commercial Support and Sponsorship
No commercial support or sponsorship has been received for this on demand
continuing education activity.