An update on nutrition support in the critically ill

Area of Science:

• Critical care medicine
• Nutritional science
• Clinical nutrition

Background:

• Nutrition support has evolved from adjunctive to fundamental in critical care.
• Early enteral nutrition (EN) is recommended over parenteral nutrition (PN) due to evidence of reduced mortality and infectious complications.

Purpose of the Study:

• To review current evidence and identify controversies in nutrition support for critically ill patients.
• To highlight areas requiring further high-quality research.

Main Methods:

• Review of high-grade evidence and recent publications on nutrition support in critical illness.
• Analysis of outcomes related to early EN versus PN.
• Examination of specific patient populations (obese) and nutrient interventions.

Main Results:

• Early EN is associated with decreased mortality and infections compared to PN.
• Strategies like prokinetics and feeding protocols can minimize EN risks.
• Hypocaloric feeding with increased protein benefits obese patients.
• Optimal caloric intake for nonobese patients and the role of IV fat emulsions require more study.

Conclusions:

• Early EN is a cornerstone of critical care nutrition, with benefits outweighing risks when managed properly.
• Further research is essential to define optimal feeding strategies for specific patient groups and clarify the role of immune-enhancing nutrients.