Nutrition in the critically ill patient

Malnutrition in critically ill patients is associated with increased morbidity and mortality. The stress response to severe illness results in altered substrate availability and utilisation. Nutritional support is a vital part of patient management in critical care units and can be administered enterally, parenterally or in combination. Feeding regimens aim to provide essential nutrients with minimum risk. The enteral route has benefits over and above the supply of nutrition, playing a role in maintenance of gut integrity and protecting against bacterial translocation across the gut wall. Successful enteral feeding may require the use of feeding protocols incorporating the use of prokinetics to achieve adequate nutrient delivery. Parenteral nutrition is associated with significant problems and complications and its use should be reserved for those patients in whom enteral feeding is unlikely to be established for at least 7 days or the patient who is intolerant to enteral feed. The role of immunomodulatory dietary supplementation is inconclusive and randomised clinical trials of immune-enhanced feeds have failed to show a clear benefit in critically ill patients. © 2006 Elsevier Ltd. All rights reserved.