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The results of this trial support other studies associating
higher energy intakes during the acute phase of critical illness with increased hospital mortality.39,40 The average protein provision in this study was 48% of estimated protein
requirements and the impact of under-dosing protein on mortality is unclear. It is also unclear if the route or type of nutrient formulation impacted results because this was not
reported. For example, a high carbohydrate dose may have
contributed to hyperglycemia and administration of SO-based
ILE products (including propofol) may have contributed to
inflammation and impaired pulmonary gas exchange. While
results were reported as adjusted per insulin received, adequacy of glycemic control is unknown. The authors' conclusions imply that reproducibility was accomplished between
this trial and the original INTACT study; however, differences in baseline characteristics between the 2 groups of
study patients exist and must be taken into consideration.
The ENP cohort had a lower mean APACHE II score (22.5 vs
27.7), lower average BMI (ENP cohort was predominantly
overweight while INTACT patients were obese), a higher
percentage of malnourished patients (50% vs 37%), and
energy provision appears to have commenced up to 3 days
later in the ENP cohort as acute respiratory distress syndrome
diagnosis was not made until day 3 of ICU admission.
Finally, there are questions regarding the feasibility of shortterm caloric provision producing meaningful impacts on
mortality a day later. This study is hypothesis generating and
suggests prospective, randomized controlled trials are needed
to determine optimal energy and protein provision accounting for potential differences in nutrient formulations during
the first 7 days of ICU admission compared to after 7 days in
mechanically ventilated, critically ill patients.

Conclusion
With the large volume of publications pertinent to nutrition
support therapy and their appearance in a variety of journals,
it is extremely difficult for the pharmacist engaged in nutrition support practice to stay current with the literature.1 We
have identified what the author participants consider to be
the "most important" papers from the primary literature to
pharmacy nutrition support practice and provided an additional list of pertinent guidelines, consensus, and recommendation papers from various organizational groups. Although
only those highest ranked articles by a majority consensus
were discussed, other publications may be important depending on the patient population and the role of the pharmacist at
a specific institution. The methodology used for collection of
articles for this article has the limitation that the process for
identifying significant articles lacked a consistent structured
literature search strategy. As a result, it is possible that omission of pertinent articles applicable to pharmacy nutrition
support practice that were published in less common journals
and not routinely read by the author participants were not
identified.

Hospital Pharmacy 54(5)
We recommend pharmacists engaged in nutrition support
therapy be familiar with those articles that are applicable to
their clinical practice. It is suggested that the list of other
articles in the supplemental online document also be
reviewed to identify those publications that might be pertinent to the reader's clinical practice.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplemental Material
Supplemental material for this article is available online.

ORCID iD
Roland N Dickerson

https://orcid.org/0000-0002-2086-6317

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https://www.orcid.org/0000-0002-2086-6317

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