Welcome to the 2021 Systematic Reviews by Critical Care Nutrition

Once again, we’ve systematically reviewed 53 topics on critical care nutrition and have posted our updated summaries on our website. We have included all RCTs of nutritional interventions involving critically ill patients examining clinically important outcomes published since 1980 (See our protocol below). The included studies have undergone a formal review by our review committee and data have been extracted in duplicate.

The updated Systematic reviews are being made available starting in February 2021 and all will hopefully be updated by the end of March 2021. Refer to the topics below for a full list of the topics and for links to the available systematic reviews.

We are hoping you find these summaries of evidence updates helpful in your day-to-day practice. Also, we wanted to offer a thank you to our collaborators who worked on this update. This would not possible without a full team effort. 

For those interested in citing these systematic reviews, we encourage you to use the following citation:

Heyland DK, Lee Z-Y, Yap C., Ortiz LA, Clarke J, Dhaliwal R. [insert the systematic review title]. Critical Care Nutrition, March 2021

Review Committee:
Dr. Daren Heyland
Dr Jayshil Patel
Zheng Yii Lee, PhD
Luis Alfonso Ortiz Reyes, MSc
Dr Aileen Hill
Cindy Yap, BSc
John Clarke, MSc, RKin
Rupinder Dhaliwal, RD

Protocol (updated May 2021)
Summary of Changes (2018 vs 2021 Systematic Reviews)
2018 Systematic Reviews

2021 Systematic Reviews, by topic

   1.0   The use of Enteral Nutrition vs Parenteral Nutrition 
   2.0   Early vs. Delayed Nutrient Intake (May 2021)
   3.1   Indirect calorimetry vs. Predictive equations (Enteral Nutrition) (REVISED)
   3.2   Achieving Target Dose of Enteral Nutrition  
   3.3a   Trophic vs Full Feeds  
   3.3b   Hypocaloric EN
   4.1a   Composition of EN: Diets with arginine and other nutrients
   4.1b(i)   Composition of EN: Fish oils, borage oils, & antioxidants
   4.1b(ii)   Composition of EN: Fish oils alone
   4.1c   Composition of EN: Immune Enhancing diets - Glutamine
   4.1d   Composition of EN: Immune Enhancing Diets - Ornithine KetoGlutarate (OKG)
   4.2a   Composition of EN: CHO/Fat: High fat/Low CHO
   4.2b   Composition of EN: CHO/Fat: Low fat/High CHO
   4.2c   Composition of EN: High Protein vs. Low Protein (July 2021) (Published paper)
   4.2d   Composition of EN: Fat Modified 
   4.3   Composition of EN: Protein/peptides 
   4.4   Composition of EN: pH
   4.5   Fibre
   5.1   Feeding Protocols
   5.2a   Use of Motility Agents
   5.2b   Motility Agents vs Intestinal Feeding
   5.3   Small Bowel vs. Gastric Feeding (May 2021)
   5.4   Body Position
   5.5a   Gastric Residual Volumes Thresholds (GRVs) (New topic)
   5.5b   Gastric Residual Volumes Monitoring (GRVs) (New topic)
   5.5c   Gastric Residual Volumes Frequency (GRVs) (New topic)
   5.5d   Discarding Gastric Residual Volumes (GRVs)
   5.6   Fasting
   6.1   Closed vs. Open Systems
   6.2   Enteral Nutrition: Prebiotics/Probiotics/Synbiotics
   6.3   Enteral Nutrition: Continuous vs. Other Methods of Administration
   6.4   Enteral Nutrition: Gastrostomy vs. Nasogastric Feeding
   6.5   Enteral Nutrition: HMB
   7.1   Combination EN + PN
   7.2   Early vs. Delayed Supplemental PN
   8.0   Parenteral Nutrition vs. Standard Care
   9.1   Composition of PN: Branched Chain Amino Acids
   9.2   Composition of PN: Type of lipids (Jan 2022) (Published paper)
   9.3   Composition of PN: Zinc (alone or in combination)
   9.4a   Composition of PN: Glutamine Supplementation
   9.4b   Composition of PN: Glutamine Supplementation + EN Supplementation
   9.4c   Composition of PN: EN vs PN Glutamine
   9.5   Composition of PN: Protein and Amino Acids (July 2021) (Published paper)
   10.1   Strategies to Optimize Parenteral Nutrition: Dose of PN
   10.2   Use of lipids 
   10.3   Mode of lipid delivery  
   10.4a   Optimal glucose control: Insulin therapy
   10.4b   Optimal glucose control: Carbohydrate restricted formula + insulin therapy
   11.1   Antioxidant Nutrients: Combined Vitamins and Trace Elements
   11.2   Antioxidant Nutrients: Parenteral Selenium (alone or in combination) 
   11.3   Vitamin C (Sept 2021) (Published paper)
   12.0   Vitamin D 
   13.0   Thiamine


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