ESPEN has revised its 2019 guideline on clinical nutrition in intensive care into a shorter practical document, built around flow charts, under the society's new standard operating procedures. Every topic from the previous guideline is retained, including the special conditions, and the stated purpose is implementation rather than evidence review.
Nutrition is the part of intensive care most often deferred and least often audited. It is prescribed on admission, rarely revisited, and interruptions for procedures, extubations and imaging accumulate until a patient who was prescribed full feeding has received a fraction of it. A guideline nobody can navigate at 3 am does not fix that; a flow chart might.
The practical step is to use this version as the basis for a unit protocol and a feeding audit rather than reading it as a text. Two questions are worth asking of your own unit before the guideline arrives: what proportion of prescribed feed is actually delivered, and who is responsible for restarting it after an interruption. In Indian units, where malnutrition is frequently present on admission rather than acquired during it, the deficit starts earlier and the accumulated gap matters more.
- Use the practical version as the basis for a unit protocol, not as a document to read through.
- Audit delivered feed against prescribed feed - the gap is where the deficit accumulates.
- Name who restarts feeding after a procedure, extubation or imaging interruption.
- Assess nutritional status on admission; in Indian units malnutrition often precedes the illness.
- This is a repackaging of the 2019 guideline with partial revision, not a new evidence base.
Why it matters
Feeding is prescribed once and eroded daily by interruptions nobody owns, and a guideline built as flow charts is aimed at exactly that failure.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for emergency & critical care, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free