Critical Care Nutrition: Where's the Evidence?

Abstract

The surgical critically ill patient is subject to a variable and complex metabolic response, which has detrimental effects on immunity, wound healing, and preservation of lean body muscle. The concept of nutrition support has evolved into nutrition therapy, whereby the primary objectives are to prevent oxidative cell injury, modulate the immune response, and attenuate the metabolic response. This review outlines the metabolic response to critical illness, describes nutritional risk; reviews the evidence for the role, dose, and timing of enteral and parenteral nutrition, and reviews the evidence for immunonutrition in the surgical intensive care unit.

Keywords: Critical care nutrition; Enteral nutrition; Metabolic stress response; Nutritional risk; Parenteral nutrition; Permissive underfeeding; Supplemental parenteral nutrition; Trophic feeding.