Severe metabolic alterations frequently occur in critically ill patients. If
nutrition plays an important role in critical care, what are the needs for
critically ill patients?
The patients that we wish to feed properly are stressed in different ways
and very often in more than one way. The word ‘stress’ appears in the
nutrition and clinical nutrition literature attached to a wide variety of
The term ‘sepsis’ refers to the host’s systemic inflammatory response to
an invasive microbial challenge; when the clinical constellation includes
hypotension and/or concurrent end-organ injury, the condition is known as
‘severe sepsis’ or ‘septic shock’.
Burn patients have the highest metabolic rate of all critically ill or injured
patients. The metabolic response to a severe burn injury is characterized
by a hyperdynamic cardiovascular response, increased energy expenditure,
accelerated glycogen and protein breakdown, lipolysis, loss of lean body mass
and body weight, delayed wound healing, and immune depression [1, 2].
The general approach to the nutritional care of the catabolic, malnourished
or critically ill patient involves delivery of a balanced diet including energy
(in the form of carbohydrates and lipids), an adequate amount of nitrogen,
all essential nutrients (amino acids, fatty acids, vitamins, electrolytes) and
Lipid metabolism is altered in the critically ill patient as a result of changes
in the status of hormones and other mediators [for reviews see, 1–3]. Enhanced
mobilization of adipose tissue triacylglycerol stores is characteristic of the
metabolic response to severe stress.
Trace elements and vitamins are essential components of nutrition (unless
specified, vitamins and trace elements will hereafter be designated globally as
It is difficult to give a simple answer to this question for a number of
reasons. Firstly, because the major determinants of outcome on the ICU are
the severity of the disease, coincident cardiorespiratory pathology, sepsis and
Parenteral nutrition has significantly advanced the survival of patients who
sustain major loss to the GI tract or prolonged delayed ability to take oral or
For patients who survive the first 48 h of intensive care, sepsis-related
multiple organ failure (MOF) is the leading cause for prolonged intensive care
unit (ICU) stays and deaths.
Advances in mechanical ventilation, the use of pulmonary surfactants,
improved pharmacological management of expectant mothers and preterm
infants and greater confidence in our overall intensive care techniques have
resulted in a marked increase in the number of very immature infants who
Obesity is a common medical condition affecting more than 1 in 10 adults
in Western European countries . Its prevalence varies considerably in
different countries. In Europe, it amounts to about 10–15% of the middleaged
That pancreatic rest and a reduction in exocrine secretion may allow a
more expedient resolution of pancreatic inflammation is an important clinical
precept in the management of patients with acute pancreatitis.
The scope of this review is to provide practical guidelines for nutritional
management of critically ill patients with sepsis with or without multiple
organ failure (MOF).
The importance of nutritional support in surgical patients cannot be
overstated, particularly in the realm of intensive care settings. Prevention of
mucosal atrophy and stimulation of the gut-associated lymphoid tissue
(GALT) by early enteral feeding in postoperative surgical patients has only
recently become part of our standard of care.
Severe injury causes alterations in protein metabolism , including net
muscle protein breakdown, increased transfer of amino acids (AAs) from the
peripheral to the splanchnic area, intense use of AAs for gluconeogenesis and
consequently a marked increase in nitrogen loss, leading to a negative
nitrogen balance .
The most prominent metabolic alterations which characterize the systemic
inflammatory response syndrome and sepsis include hypermetabolism,
hyperglycemia with insulin resistance, accelerated lipolysis and net protein