How to Feed Critically Ill Patients

Nutrition therapy is challenging in critically ill patients.Critical illness is associated with catabolic stress, in which stress hormones and inflammatory mediators are activated, resulting in proteolysis.The goals of nutrition therapy in critically ill patients are to preserve lean body mass, to preserve immune function, and to avoid metabolic complications.Limited physiologic reserves mandate a comprehensive approach and monitoring.Enteral nutrition is preferred over parenteral nutrition unless the patient is hemodynamically stable and enteral feeding is contraindicated.Early enteral nutrition is recommended within 24 to 48 hours of intensive care unit admission.If enteral nutrition is not feasible within several days, supplementary parenteral nutrition is necessary.In the acute phase, energy requirements should be less than 20 to 25 kcal/kg/day; in the recovery phase, more than 30 to 35 kcal/kg/day.Protein should be supplemented in the range of 1.2 to 2.0 g/kg/day.Monitoring for tolerance of enteral nutrition to avoid complications is very important in critically ill patients.An immune modulating effect of immunonutritional components such as glutamine or omega-3 fatty acids can occur in specific diseases.In conclusion, comprehensive nutrition therapy plays an important role in clinical outcomes.(