Nutritional Support in the Surgical Critical Care Patient

Abstract

Optimal nutritional support is fundamental to modern intensive care unit (ICU) care, as critically ill patients often exhibit a catabolic stress state that is associated with significant loss of lean body mass and increased morbidity and mortality. Historically one of the main problems with providing high-quality ICU nutrition was the lack of a robust and high-quality evidence base, with very few large randomized trials conducted. However, over the past two decades, there has been an explosion of outstanding nutrition research including multiple large and multicenter randomized trials. The problem faced by the modern ICU physician now is not the lack of an evidence base, but rather the difficulty in parsing the continually increasing body of literature on this topic. In addition, despite the recent decades of experience and research, the evidence for deciding who needs support, how much and when to deliver it, the optimal route and contents, and the underlying pathophysiologic mechanisms remain heavily debated. The purpose of this chapter is to provide a concise and clinically focused review of the current data for nutritional support in the ICU patient, to outline suggested practices and procedures, and to identify key differences or alterations that should be applied in select subgroups of surgical or trauma ICU patients.