Nutritional care of the injured and/or septic patient

Nutritional therapy is influence both by disease and nutritional status. In addition, the degree of protein depletion in large part dictates the urgency of aggressive nutritional therapy. The presenceof hypermetabolism where the hormonal substrate response is distinctly antagonistic to replacement therapy precludes effective repair of nutritional depletion. Sepsis further antagonizes efforts at nutritional support. For these reasons no elective or semielective procedure that carries a risk of prolonged stress, hypermetabolism, and sepsis should be performed until adequate nutritional status has been obtained. Enteral feeding programs are to be preferred due to their risk-benefit and cost-benefit ratios. However, impaired digestive function related to disease often limits their use and reliance on parenteral nutrition becomes necessary. While each patient has unique needs and responses, a systematic approach based on objective measurements will most often result in effective nutritional therapy. The accomplished therapist will apply the "modular" approach using the wide variety of products and techniques now available. Ignoring the support of protein synthesis and the preservation of lean body mass can no longer be considered good patient care even in the management of the semistarved state. There is no longer any justification for allowing nosocomial malnutrition to alter the morbidity and mortality of disease. With proper skills in the techniques of protein-calorie therapy and the availability of adequate techniques for nutritional assessment, the science of nutritional therapy now affords the opportunity to provide optimal care for the injured hospitalized patient.