[Nutrition in intensive care]

Nutrition is a supportive therapy in critically ill patients. The caloric need of a patient is not static and may change during the clinical course. Early enteral nutrition helps preventing an energy deficit of the patient leading to an increased rate of secondary infections and prolonged length of stay. By using protocols early enteral nutrition may be improved with benefit for the critically ill. Patients should not receive hypercaloric nutrition. Supplemental parenteral nutrition should be used to minimize the gap between energy needs and enteral supplied calories. Nutrition should be supplied according to metabolic and enteral tolerance. A strict glucose control is not recommended to all patients any more. Hyperglycemia may be part of the adaptive response to stress, infection, and trauma. It is important to avoid hypoglycaemia and increased variability in glucose concentrations. To this end, structured local protocols with instructions for sampling density, glucose and insulin administration, avoidance and treatment of hypoglycaemia should be installed. There are contradictory data on the use of probiotics in critically ill patients. Among patients with severe acute pancreatitis, more patients died after having received probiotics. The use of probiotics should be evaluated in controlled trials. Adherence to guidelines may be improved, and their appliance should be followed by constant training and evaluation processes.