Nutrition support for critically ill patients.

Area of Science:

• Critical care medicine
• Clinical nutrition
• Gastroenterology

Background:

• Nutrition support is vital for critically ill patients.
• Understanding the interplay between critical illness, the GI tract, and nutrition is key.
• Accurate energy expenditure measurement is challenging, with predictive equations showing limitations.

Purpose of the Study:

• To review emerging evidence on critical care nutrition.
• To focus on the pathophysiology linking critical illness, the GI tract, and nutrition.
• To evaluate the optimal route, dose, and timing of nutrition support.

Main Methods:

• Literature review of current evidence on critical care nutrition.
• Analysis of pathophysiologic mechanisms.
• Evaluation of clinical trial data on nutrition delivery methods.

Main Results:

• Early enteral nutrition (EN) is supported for most critically ill patients, with gradual dose escalation.
• Delayed EN is advised for patients in severe shock.
• Parenteral nutrition is as effective as EN and can be initiated if EN is inadequate within the first week.

Conclusions:

• Early EN is generally preferred, but parenteral nutrition is a viable alternative.
• High protein intake is suggested, but optimal timing requires further research.
• Immuno-nutrition is not routinely recommended; metabolic monitoring is essential for patients on artificial nutrition.