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Critical Care Nutrition at the Clinical Evaluation Research Unit (CERU)

is dedicated to improving nutrition therapies in the critically ill through knowledge generation, synthesis, and translation. We engage in a broad range of research activities and promote a culture of best practices in critical care nutrition. Ultimately, this will result in improved clinical outcomes for critically ill patients and increased efficiencies to our health care systems.

The 2013 Clinical Practice Guidelines summarized the evidence from approximately 300 randomized controlled trials in the area of critical care nutrition since 1980. The 2013 guideline update and implementation strategies is published in Nutrition in Clinical Practice.

The included studies underwent a formal review process by the Canadian Clinical Practice Guidelines Committee and provided the latest and best evidence for clinical practice in the various areas of critical care nutrition. These guidelines were developed in collaboration with the Canadian Critical Care Society (CCCS) and the Canadian Critical Care Trials Group (CCCTG).

List of new randomized controlled trials included under each topic (n=80).

Summary of Recommendations 2013 vs. 2009.

The guidelines summarizes the evidence from 67 new randomized controlled trials since the 2009 Guidelines.

There are a total of 45 recommendations under 12 main topics and several sub topics.

New! There are 10 new sections under the topics of Intentional Underfeeding, Gastric Residual Volumes, Early vs. late Parenteral nutrition, Fish Oil supplementation, Combined Enteral and Parenteral Glutamine, Optimal Glucose Control & Vitamin D.

Spanish translations available of the Summary of Recommendations and each CPG topic.

Updated April 9th, 2013

1. The use of Enteral Nutrition vs. Parenteral Nutrition (EN vs. PN)


March 2013

(Click here for 2009 version)

2. Early Vs Delayed Nutrient Intake


March 2013

(Click here for 2009 version)

3. Nutritional Prescription (dose) of Enteral Nutrition


March 2013

3.1 Indirect Calorimetry vs. Predictive
(Click here for 2009 version)



March 2013

3.2 Achieving Target Dose of Enteral Nutrition
(Click here for 2009 version)

3.3 Intentional Underfeeding



March 2013

New!3.3a Trophic Feeds vs Full Feeds



March 2013

New!3.3b Hypocaloric Enteral Nutrition

4. Composition of Enteral Nutrition

4.1 Immune Enhancing Diets


March 2013

4.1a Diets Supplemented with Arginine and Select Other Nutrients
(Click here for 2009 version)



April 2013

4.1b i) Fish Oils, Borage Oils and Antioxidants
(Click here for 2009 version)



March 2013

New!4.1b ii) Fish oils supplementation

4.2 Carbohydrate/Fat

5. Strategies to Optimize Delivery and Minimize risk of Enteral Nutrition



March 2013

New!5.5 Threshold of Gastric Residual Volumes



March 2013

New!5.6 Discarding Gastric Residual Volumes

6. Enteral Nutrition: Other



March 2013

6.3 Continuous vs. other methods of administration
(Click here for 2009 version)



March 2013

6.4 Gastrostomy vs. Nasogastric feeding
(Click here for 2009 version)



March 2013

New!6.5 Other Formulas

7. Enteral Nutrition plus Parenteral Nutrition


March 2013

7.1 Combination Enteral and Parenteral Nutrition
(Click here for 2009 version)



March 2013

New!7.2 Early vs Delayed Supplemental PN

8. Parenteral Nutrition vs. Standard care


March 2013

(Click here for 2009 version)

9. Composition of Parenteral Nutrition



March 2013
Full Summary
Coming Soon!

9.4a Parenteral Glutamine Supplementation
(Click here for 2009 version)



April 2013

New!9.4b Combined Parenteral and Enteral Glutamine Supplementation

10. Strategies to Optimize Parenteral Nutrition



March 2013

10.4a Optimal glucose control: Insulin therapy
(Click here for 2009 version)



March 2013

New!10.4b Optimal glucose control: Carbohydrate restricted formula and insulin therapy

11. Supplemental Antioxidants


April 2013

11.1 Combined Vitamins and Trace Elements
(Click here for 2009 version)



April 2013

11.2 Parenteral Selenium (alone or in combination)
(Click here for 2009 version)

New!12. Vitamin D


March 2013
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