• Yaseen M Arabi, Michael P Casaer, Marianne Chapman, Daren K Heyland, Carole Ichai, Paul E Marik, Robert G Martindale, Stephen A McClave, Jean-Charles Preiser, Jean Reignier, Todd W Rice, Greet Van den Berghe, van ZantenArthur R HARHDepartment of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan, Ede, The Netherlands., and WeijsPeter J MPJMNutrition and Dietetics, Department of Internal Medicine, and Department of Intensive Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.Department of Nutrition and Dietetics, School of Sports and Nutrition, Amsterdam.
• Intensive Care Department, MC 1425, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. arabi@ngha.med.sa.
• Intensive Care Med. 2017 Sep 1; 43 (9): 1239-1256.

PurposeThe objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years.MethodsRecent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism. Then, members of the panel rated each one of the topics using a grading system (0-4). Potential studies were ranked on the basis of average score.ResultsRecent randomized controlled trials (RCTs) have challenged several concepts, including the notion that energy expenditure must be met universally in all critically ill patients during the acute phase of critical illness, the routine monitoring of gastric residual volume, and the value of immune-modulating nutrition. The optimal protein dose combined with standardized active and passive mobilization during the acute phase and post-acute phase of critical illness were the top ranked studies for the next 10 years. Nutritional assessment, nutritional strategies in critically obese patients, and the effects of continuous versus intermittent enteral nutrition were also among the highest-ranking studies.ConclusionsPriorities for clinical research in the field of nutritional management of critically ill patients were suggested, with the prospect that different nutritional interventions targeted to the appropriate patient population will be examined for their effect on facilitating recovery and improving survival in adequately powered and properly designed studies, probably in conjunction with physical activity.

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