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Optimizing Enteral and Parenteral Nutrition in Critically Ill Patients

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: 15 June 2026 | Viewed by 785

Special Issue Editor


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Guest Editor
Department of Surgery, UCSF—East Bay, Oakland, CA, USA
Interests: intestinal failure; surgical critical care; enterocutaneous fistula; nutrition support; trauma; antibiotic stewardship

Special Issue Information

Dear Colleagues,

There has been a tremendous paradigm shift in how we approach nutrition optimization for the critically ill over the past 10 years. Many large, randomized trials have tackled the safety and role of parenteral nutrition as well as strategies for enteral nutrition delivery within the acute stages of critical illness. Much of what we are learning is paradoxical to the traditional way clinicians have viewed nutrition and nutrition delivery. It is truly an innovative time to investigate these topics, as the field remains in its infancy with limited understanding of how to assist the human body during critical illness. Additionally, several publications have focused on the role of micronutrient supplementation and its safety and function in this population. Nonetheless, several serious unknowns remain, especially for surgical critically ill patient populations. This Special Issue aims to feature major large-scale trials that could change clinical practice while focusing on topics that remain understudied and uncertain. We will also cover possible basic science principles that can explain observations in clinical trials.

Dr. April Mendoza
Guest Editor

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Keywords

  • critical illness
  • autophagy
  • protein
  • enteral nutrition
  • parenteral nutrition
  • permissive underfeeding
  • ascorbic acid
  • thiamine
  • bowel ischemia
  • enteral intolerance

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Published Papers (1 paper)

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Review

12 pages, 252 KB  
Review
Fish Oil-Containing Injectable Lipid Emulsions in Parenteral Nutrition: Immunomodulation and Clinical Outcomes in Critically Ill Patients—Narrative Review
by Mariusz Kęska, Milena Kęska, Mirosław Perliński, Piotr Pabich and Dariusz Onichimowski
Nutrients 2026, 18(6), 939; https://doi.org/10.3390/nu18060939 - 17 Mar 2026
Viewed by 564
Abstract
Background and Aims: Injectable lipid emulsions are an integral component of parenteral nutrition, providing energy as well as essential fatty acids. However, conventional soybean oil–based emulsions, which are rich in omega-6 fatty acids, are associated with a risk of exacerbating pro-inflammatory responses and [...] Read more.
Background and Aims: Injectable lipid emulsions are an integral component of parenteral nutrition, providing energy as well as essential fatty acids. However, conventional soybean oil–based emulsions, which are rich in omega-6 fatty acids, are associated with a risk of exacerbating pro-inflammatory responses and immunosuppression, which is of particular importance in critically ill patients. The aim of this review is to present the significance of the composition of modern injectable lipid emulsions, with particular emphasis on emulsions containing fish oil as a source of omega-3 fatty acids (EPA and DHA), and to discuss their potential clinical benefits in selected critical conditions. Methods: This narrative review discusses the rationale for modern mixed-oil ILE, with a focus on fish oil as a source of EPA and DHA, and summarizes potential clinical benefits in selected critical care settings. Results: Modern injectable lipid emulsions combine long-chain triglycerides derived from soybean oil (omega-6), MCTs, olive oil (omega-9), and fish oil (omega-3). Adjusting the supply of individual fractions affects cell membrane structure, signaling pathways, gene expression, and the profile of lipid mediators produced, including specialized pro-resolving mediators (SPMs). ESPEN guidelines and international recommendations emphasize the need to use lipids in parenteral nutrition, preferring mixed-oil ILE supplemented with fish oil. The cited meta-analyses and clinical studies indicate that omega-3-containing emulsions may reduce the risk of infections and sepsis; shorten hospital stay, ICU length of stay, and duration of mechanical ventilation in patients with sepsis; as well as improve outcomes in acute pancreatitis; lower the risk of delirium; and reduce the incidence of delayed gastric emptying. Conclusions: Available data support the use of mixed-oil ILE supplemented with fish oil in the parenteral nutrition of critically ill patients as a strategy with immunomodulatory and pro-resolving potential that may translate into improved clinical outcomes. However, further well-designed randomized trials are needed to optimize dosing and administration regimens. Full article
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