Specialized nutrition support in the critically ill: for whom and when?

For the purpose of this article, ‘specialized nutrition support’ means using nutrient formulations that have particular adaptations deemed either to alter the inflammatory response or correct a conditional deficiency. The term ‘immunonutrition’ is widely used. For ‘whom’ requires an understanding of the pathological processes patients are undergoing and ‘when’ implies there is some optimal intervention window. However, implicit in both is the need to understand the objectives of the nutritional intervention and the balance between the benefits and risks involved and how these relate to outcome. The focus will be on the survival of critically ill patients and how we can make decisions that are of practical consequence for the general clinician.