praCtiCal aspECts of nutritional thErapy and Blood gluCosE lEvEl in CritiCally ill patiEnts

the main goal of nutritional support in critically ill patients is to minimize the negative protein balance by avoiding starvation, with the purpose of maintaining muscular, immune, and cognitive function, as well as to enhance recovery. nutrition can be given either by the enteral or the parenteral route. Patients should be provided with nutritional substrates, because starvation or underfeeding in intensive care unit (icu) patients is associated with increased morbidity and mortality. the guidelines of european society for clinical nutrition and Metabolism (esPen) and canadian society for clinical nutrition (cscn) recommend the initiation of enteral nutrition within 24-48 hours after the admission to icu. total parenteral nutrition (tPn), if indicated, should also be initiated within the first 24-48 hours after icu admission. the minimal amount of carbohydrate required is about 2 g of glucose/body weight per day. hyperglycemia above 180mg/dl (>10 mmol/l) may have fatal consequences for critically ill patients and should also be avoided. insulin therapy should be initiated for persistent hyperglycemia, with decision threshold no greater than 180 mg/dl, with a target glycemia range of 140 to 180 mg/dl for the majority of critically ill patients. intravenous insulin infusions adjusted according to validated protocols with demonstrated safety and efficacy are preferred.