Protein and caloric or macronutrient metabolic management of the critically ill patient

Aggressive and early use of nutritional support therapies in critically ill patients represents a major advance in critical care medicine. The net protein catabolism and erosion of protein stores which is characteristic of the metabolic response to injury results in significant added morbidity and mortality in critical care units. The early administration of appropriate protein and energy in support of enhanced demands will maintain host defense and preserve organ function, thus, allowing time for stabilization of clinical status while life support strategies are implemented. In all circumstances, protein, vitamins, minerals, and nonprotein calories must be provided within fluid and electrolyte restrictions and in conjunction with optimal hemodynamic and pulmonary support.