Enteral / Parenteral Nutrition Planner (ICU)
Clinical calculators
These tools do not replace clinical judgment. Results should be interpreted together with physician assessment, current guidelines, and the patient's clinical context.
Enteral / Parenteral Nutrition Planner (ICU)
This tool calculates the daily energy and protein target for the adult ICU patient. Based on the selected formula, it shows the daily volume, tube infusion rate, protein deficit, and the amount of protein module needed to close this deficit. It prepares a printable nutrition report with optional patient information; this information remains only in the browser and is not sent to the server.
When to use
This planner is used in the adult intensive care patient who is to start enteral or parenteral nutrition. It is useful in clinical situations where an energy target must be determined with a weight-based equation in the absence of indirect calorimetry, a refeeding-safe starting rate must be calculated in a patient with prolonged fasting or significant weight loss, and the appropriate infusion rate must be found to meet this target with a specific commercially available formula or TPN bag. It also provides decision support by showing which calculation weight should be used in the obese patient.
Formula
Ideal weight is calculated with Devine: male 50 + 2.3×(height/2.54−60), female 45.5 + 2.3×(height/2.54−60); the lower limit in this tool is 30 kg. For BMI≥30, the energy calculation weight is the ESPEN adjusted weight: the weight corresponding to BMI 25 (25 × height², m) + 0.33 × (actual weight − this weight). The low-calorie approach of ASPEN/SCCM 2016 (11–14 kcal/kg actual weight for BMI 30–50, 22–25 kcal/kg ideal weight for BMI>50) is also shown separately for comparison. Energy = kcal/kg × energy calculation weight. Protein = g/kg × selected protein weight; in automatic selection, the ≥2 g/kg target in obesity is applied to ideal weight, and in other cases to the energy calculation weight. Formula volume = period energy / kcal/mL or the manually entered daily volume. Formula protein = volume × g/100 mL / 100; deficit = max(0, target−formula protein). If volume is maintained, powder = deficit / protein ratio of the powder. If energy is maintained, powder = deficit / [protein ratio−(powder kcal/g × formula protein g/mL / formula kcal/mL)]; the formula volume is reduced by the calories of the powder. The powder amount is rounded up by 0.1 g; a negative formula volume is not recommended. Pump rates are calculated as volume/24, volume/18 and volume/19.2. The theoretical carbohydrate/fat distribution is not the actual composition of the formula. TPN GIR is derived only from the glucose in the bag, as glucose g×1000/(actual weight×1440).
Interpretation
If indirect calorimetry is available, the measured energy expenditure is taken as the basis. ESPEN 2023 recommends a hypocaloric approach (<70% of estimated requirement) in the first week when feeding with an estimated equation and stepwise administration of 1.3 g/kg/day protein. For measured energy, the recommendation of 80–100% after day 3 does not mean an automatic switch to the full target based on estimated energy. In this tool, the Full target stable/post-acute plan indicates the target, while the Early acute selection indicates the initial upper limit. If refeeding risk is selected, the initial calculation takes precedence; the calculation is capped at 10 kcal/kg/day in high risk and at 5 kcal/kg/day in very high risk, based on NICE CG32. Energy restriction alone does not eliminate refeeding risk; thiamine, electrolytes and clinical monitoring are required. A module dose that closes the protein deficit at once in the early period is not given. The powder amount shown in the stable period is only a mathematical option; physician/dietitian approval is required, taking into account the local label, allergy, organ function and tolerance. ≥2 g/kg protein is not a routine intensive care target. Enteral product/powder is not administered via the vascular route; TPN lines are the full-target alternative to the enteral plan, not the sum of the two plans.
References
- Singer P, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr. 2023;42(9):1671-1689. PMID: 37517372.
- Compher C, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: ASPEN/SCCM. JPEN J Parenter Enteral Nutr. 2022;46(1):12-41. PMID: 34784064.
- McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: SCCM and ASPEN. JPEN J Parenter Enteral Nutr. 2016;40(2):159-211 (obez hasta önerileri).
- National Institute for Health and Care Excellence (NICE). Nutrition support for adults, CG32 — refeeding risk (10/5 kcal/kg başlangıç, tiamin, elektrolit). nice.org.uk/guidance/cg32.
- da Silva JSV, et al. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract. 2020;35(2):178-195. PMID: 32115791.
- Devine BJ. Gentamicin therapy (ideal body weight formülü). Drug Intell Clin Pharm. 1974;8:650-655.
- Heyland DK, et al. The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet. 2023;401(10376):568-576. PMID: 36708732.
- Stoppe C, et al. The impact of higher protein dosing on outcomes in critically ill patients with acute kidney injury: a post hoc analysis of the EFFORT protein trial. Crit Care. 2023;27(1):399. PMID: 37853490.
For ADULT patients ONLY; it is for decision support and does not replace physician judgment. Calculation weight, clinical status and organ functions change the plan. Formula/TPN compositions must be verified exactly from the manufacturer's package insert (formulations may vary by country/batch). In refeeding risk, thiamine 200–300 mg before feeding and on the first day, together with electrolyte (phosphate, potassium, magnesium) monitoring and replacement, is mandatory; the glucose infusion rate must not exceed 5 mg/kg/min and lipids must not exceed 1.5 g/kg/day. Central TPN bags are not administered via a peripheral vein. Since the high protein target (2.0 g/kg and above) was associated with harm in the EFFORT-Protein trial in patients with acute kidney injury not receiving renal replacement therapy, protein selection in this group should be made with renal function assessed. This tool is for adult patients only; it is invalid in pediatric, pregnant and breastfeeding patients.
Frequently asked questions
What is Enteral / Parenteral Nutrition Planner (ICU)?
This tool calculates the daily energy and protein target for the adult ICU patient. Based on the selected formula, it shows the daily volume, tube infusion rate, protein deficit, and the amount of protein module needed to close this deficit. It prepares a printable nutrition report with optional patient information; this information remains only in the browser and is not sent to the server.
When is Enteral / Parenteral Nutrition Planner (ICU) used?
This planner is used in the adult intensive care patient who is to start enteral or parenteral nutrition. It is useful in clinical situations where an energy target must be determined with a weight-based equation in the absence of indirect calorimetry, a refeeding-safe starting rate must be calculated in a patient with prolonged fasting or significant weight loss, and the appropriate infusion rate must be found to meet this target with a specific commercially available formula or TPN bag. It also provides decision support by showing which calculation weight should be used in the obese patient.
How is Enteral / Parenteral Nutrition Planner (ICU) calculated?
Ideal weight is calculated with Devine: male 50 + 2.3×(height/2.54−60), female 45.5 + 2.3×(height/2.54−60); the lower limit in this tool is 30 kg. For BMI≥30, the energy calculation weight is the ESPEN adjusted weight: the weight corresponding to BMI 25 (25 × height², m) + 0.33 × (actual weight − this weight). The low-calorie approach of ASPEN/SCCM 2016 (11–14 kcal/kg actual weight for BMI 30–50, 22–25 kcal/kg ideal weight for BMI>50) is also shown separately for comparison. Energy = kcal/kg × energy calculation weight. Protein = g/kg × selected protein weight; in automatic selection, the ≥2 g/kg target in obesity is applied to ideal weight, and in other cases to the energy calculation weight. Formula volume = period energy / kcal/mL or the manually entered daily volume. Formula protein = volume × g/100 mL / 100; deficit = max(0, target−formula protein). If volume is maintained, powder = deficit / protein ratio of the powder. If energy is maintained, powder = deficit / [protein ratio−(powder kcal/g × formula protein g/mL / formula kcal/mL)]; the formula volume is reduced by the calories of the powder. The powder amount is rounded up by 0.1 g; a negative formula volume is not recommended. Pump rates are calculated as volume/24, volume/18 and volume/19.2. The theoretical carbohydrate/fat distribution is not the actual composition of the formula. TPN GIR is derived only from the glucose in the bag, as glucose g×1000/(actual weight×1440).
How is the Enteral / Parenteral Nutrition Planner (ICU) result interpreted?
If indirect calorimetry is available, the measured energy expenditure is taken as the basis. ESPEN 2023 recommends a hypocaloric approach (<70% of estimated requirement) in the first week when feeding with an estimated equation and stepwise administration of 1.3 g/kg/day protein. For measured energy, the recommendation of 80–100% after day 3 does not mean an automatic switch to the full target based on estimated energy. In this tool, the Full target stable/post-acute plan indicates the target, while the Early acute selection indicates the initial upper limit. If refeeding risk is selected, the initial calculation takes precedence; the calculation is capped at 10 kcal/kg/day in high risk and at 5 kcal/kg/day in very high risk, based on NICE CG32. Energy restriction alone does not eliminate refeeding risk; thiamine, electrolytes and clinical monitoring are required. A module dose that closes the protein deficit at once in the early period is not given. The powder amount shown in the stable period is only a mathematical option; physician/dietitian approval is required, taking into account the local label, allergy, organ function and tolerance. ≥2 g/kg protein is not a routine intensive care target. Enteral product/powder is not administered via the vascular route; TPN lines are the full-target alternative to the enteral plan, not the sum of the two plans.