Principles of Critical Care > Part II. General Management of the Patient > Chapter 11. Nutrition in the Critically Ill Daren K. Heyland,  Steve A. McClave

Key Points

"Nutrition support is considered an integral component of standard supportive care in the critically ill patient. In humans, during stress associated with trauma, sepsis, or other critical illness, there is high consumption of various nutrients by the gastrointestinal tract, immune cells, kidneys, and other organs. Requirements for and losses of these nutrients may outstrip synthetic capacity, leading to an erosion of body stores and depletion of proteins and other key nutrients. Historically, in an attempt to mitigate such deficiencies and preserve lean body mass, traditional nutrition (protein, calories, vitamins, etc) has been provided to critically ill patients. The relative merits of nutrition were evaluated in the context of protein-calorie economy (weight gain, nitrogen balance, muscle mass and function, etc). In this chapter we take a broader view of the benefits and risks of nutrition support. The benefits of nutrition support in general include improved wound healing, a decreased catabolic response to injury, enhanced immune system function, improved GI structure and function, and improved clinical outcomes, including a reduction in complication rates and length of stay with accompanying cost savings.¹ Independent of their effects on nutritional status of the patients, key nutrients such as glutamine, arginine, and omega-3 fatty acids may also have favorable direct effects on organ function and clinical outcomes of critically ill patients. Thus nutrition support may be considered a specific therapeutic intervention by which the critically ill patient's disease course may be altered,..."