Critical nutritional aspects in intensive care patients

Abstract

Nutrition in the critically ill patients has always been a difficult task for the intensivist. Unlike normal subjects, various physiological and pathological aspects have to be taken into consideration before initiating the nutrition in this subset of patients. The associated morbidities in critically sick patient not only pose clinical difficulties to maintain a normal nutritional status but also create various limitations in selection of a particular nutrient. Various diseases commonly found in intensive care patients produces stress on the body and bring about changes in substrate metabolism thus leading to the deficiency of various nutrients. Numerous tools and methodologies are available nowadays to predict the assessment, screening, and monitoring of the nutritional status in critically ill patients. However, the nutritional status is a big decisive factor in predicting the outcome and malnutrition has been strongly associated with increased mortality and morbidity in these patients. The nutritional requirement also varies with regards to age, body mass index, co-morbid disease, duration in ICU, and many other factors and as such the calculation for nutritional supplementation has to be done strictly on an individual basis. In all these patients, it is also vital to achieve a strict glycemic control by using insulin so as to prevent any increase in morbidity and mortality. Enteral and parenteral nutritional controversies are as old as the concept of nutrition in Intensive Care Unit (ICU). Besides therapeutic merits, both enteral and parenteral nutrition are also associated with complications which can be prevented by set protocols as well as by education of nursing personnel involved in the care of critically ill. This article reviews all these aspects concerned with nutrition in critically ill patients so as to make an effort to build a comprehensive approach and strategies for designing the nutritional supplementation.