A meeting to discuss the value, role, and open questions regarding supplemental parenteral nutrition (SPN) along with oral or enteral nutrition (EN), particularly in the setting of an intensive care unit (ICU), was held by a group of international physicians who are involved in the medical nutrition therapy (MNT) of adult critically ill patients. The group was multidisciplinary and consisted of several physicians. This manuscript summarizes the discussions and results to highlight the importance of SPN as part of a comprehensive approach to MNT in critically ill adults and for researchers to generate new evidence based on well-powered randomized controlled trials (RCTs). In addition, the importance of SPN as part of a comprehensive approach to MNT in critically ill adults is highlighted. The specialists agreed on a number of important issues, including: SPN has been proven to have therapeutic advantages, and this treatment approach is now recommended in the American guidelines. In spite of this, its application varies greatly from nation to nation. This is because a number of questions remain unanswered, such as the optimal timing and the possibility of excessive feeding in the absence of indirect calorimetry (IC). This leads to various perspectives and creates roadblocks to the implementation of SPN. Education is another area that falls short. The specialists agreed on the steps that need to be taken to improve the quality of the evidence about the use of SPN in particular patients at a given time point during acute critical illness or recovery.
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