Nutrition in the intensive care unit

Abstract

Nutritional support has become a routine part of the care of the critically ill patient. It is an adjunctive therapy, the main goal of which is to attenuate the development of malnutrition, yet the effectiveness of nutritional support is often thwarted by an underlying hostile metabolic milieu. This requires that these metabolic changes be taken into consideration when designing nutritional regimens for such patients. There is also a need to conduct large, multi-center studies to acquire more knowledge of the cost-benefit and cost effectiveness of nutritional support in the critically ill.

Figure 1

Hepatic gluconeogenesis is increased during stress. Sources of substrate include glycerol from lipolysis, alanine from proteolysis and lactate from anaerobic glycolysis.

Figure 2

Various types triglycerides are used in nutritional support. They differ in the types of fatty acids attached to the glycerol backbone. Structured lipids are currently under investigation. LCFA, long chain fatty acid; MCFA, medium chain fatty acid.