Introduction The nutritional management of critically ill patients is increasingly gaining interest. The rationale for artificial nutritional support is based on the assumption that crit- ically ill patients are prone to develop protein-energy malnutrition and that this condition is associated per se with a poor outcome and an increase in the rate of com- plications, including nosocomial infections and multiple organ failure [1]. This paradigm has been recently sub- stantiated by a significant correlation between a body mass index below the 15th percentile and mortality of critically ill patients [2]. Besides having a role in pre- venting or attenuating malnutrition, enteral feeding may protect the gut mucosal function. The use of paren- teral nutrition may be associated with specific complica- tions, including catheter infection, and cholestasis and is more expensive. Hence, the use of the enteral route is recommended to feed critically ill patients [3]. However, several shortcomings may limit the use of enteral nutri- J.C. Preiser J. BerrØ Y. Carpentier P. Jolliet C. Pichard A. Van Gossum J.L. Vincent on behalf of the Working Group on Metabolism and Nutrition of the European Society of Intensive Care Medicine Management of nutrition in European intensive care units: results of a questionnaire Accepted: 7 October 1998 With the participation of the European So- ciety for Parenteral and Enteral Nutrition. This work was supported by an educational grant form Abbott International Correspondence to: European Society of Intensive Care Medicine, 40 Ave Joseph Wybran, B-1070 Brussels, Belgium e-mail: esicm@pophost.eunet.be Abstract Objective: To describe the practical aspects of nutritional man- agement in intensive care units (ICUs). Design: A 49-item questionnaire was sent to the physician members of the European Society for Inten- sive Care Medicine. The issues ad- dressed included: medical environ- ment, assessment of nutritional sta- tus and current practice for enteral and parenteral nutrition. Setting: 1608 questionnaires were sent in 35 European countries. Analysis: The answers were pooled and stratified by country. Results: 271 questionnaires were an- swered (response rate 17 %). As- sessment of nutritional status was generally based on clinical (99 %) and biochemical (82 %) parameters rather than on functional (24 %), anthropometric (23 %), immuno- logical (18 %) or questionnaire- based (11 %) data. Two thirds of 2774 patients hospital- ised in the corresponding ICUs at the time the questionnaire was an- swered were receiving nutritional support; 58 % of those were fed by the enteral route, 23% by the par- enteral route and 19 % by combined enteral and parenteral. The pre- ferred modality was enteral nutri- tion, instituted before the 48th h af- ter admission, at a rate based on es- timated caloric requirements. Spe- cific and modified solutions were rarely used. Parenteral nutrition was less commonly used than enteral, although the practices differed be- tween countries. It was mainly ad- ministered as hospital-made all-in- one solutions, at a rate based on cal- culated caloric requirements. Conclusions: European intensivists are concerned by the nutritional management of their patients. The use of nutritional support is com- mon, essentially as early enteral feeding. Intensive Care Med (1999) 25: 95±101 Ó Springer-Verlag 1999 ESICM STATEMENT