Nutrition Support in Critically Ill Patients

This is a unique question-and-answer chapter for surgical residents and trainees, concentrating on the nutrition support in critically ill patients. The negative acute phase proteins are albumin and transferrin. Their serum concentrations fall immediately after the injury, in proportion to its severity. They are used to monitor the nutritional status of acutely ill patients. Areas of intense clinical investigation in which total parenteral nutrition (TPN) may eventually be shown to be of great value are cancer patients in general, sepsis and trauma, and general perioperative support to prevent or correct malnutrition. Although protein restriction was historically used to reduce risk from hepatic encephalopathy, such a strategy may worsen nutrition status, decrease lean muscle mass, and ironically lead to less ammonia removal. Many interacting biologic and clinical factors are responsible for the development of malnutrition in critically ill and injured hospitalized patients and also the hypercatabolic states associated with trauma, sepsis, cancer, and surgical interventions.