Nutritional support in critical care

Most critically ill patients receive some form of nutritional support during their stay in the ICU. Attempts to maintain adequate body weight and composition in the severely ill are complicated by a marked hypercatabolic response, which inevitably leads to protein loss. An evidence-based approach to ICU nutrition provides some guidance on optimal routes of feeding, feed composition, and the use of prokinetics. Recent clinical trials of immunonutrients, growth hormone, and insulin also inform the debate on best nutritional practice in the ICU. Despite several studies, many of the key issues in ICU feeding remain controversial and a pragmatic approach to nutrition is often required in practice.