Nutrition support in critically ill patients: Current status and practice

Nutrition support of critically ill patients has entered a new era of nutri-pharmaceutics. This has occurred because of recent gains in knowledge about the role of the gut in immunity and the role of nutrition in modifying the immune response after severe injury. We review the developments in this area that have potential implications for the laboratory in the assessment and monitoring of affected patients. Acute injury evokes a cytokine mediated response leading to postinjury effects that may resolve or progress. The degree of the response is proportional to the injury. It is important to assess the benefits and timing of nutritional interventions. Randomized prospective clinical trials have been done that indicate that even when the mortality is not reduced by such interventions, the morbidity, use of intense resources, and cost of critical care is decreased. The issue of morbidity is related to the development of systemic inflammatory response syndrome (SIRS), organ dysfunction, and multiple organ failure (MOF). Not only has early post- operative enteral feeding been shown to be an alternative to parenteral feeding, but the use of immunomodulators in nutrition support has an additional effect.