A SENSIBLE APPROACH TO THE NUTRITIONAL SUPPORT OF MECHANICALLY VENTILATED CRITICALLY ILL PATIENTS

Objectives. The goal of this review is to educate physicians in the details of nutritional support of mechanically ventilated critically ill patients. Design: The subtopics of this review include: introduction, goals of nutritional treatment, assessment of nutritional status, estimation of nutritional requirements, estimation of protein requirements, recommended approach to the initial nutritional regimen, route of nutrition, and monitoring the response to nutrition. Setting: The information is primarily germane to the medical management of patients with acute respiratory failure superimposed on chronic lung disease and malnutrition. Conclusion: Malnutrition is prevalent in mechanically ventilated critically ill patients. Undernutrition is associated with respiratory muscle weakness and may contribute to ventilator dependency. Overnutrition may increase CO2 production and increase ventilatory demands. This review advocates a titrated approach to nutritional management based on protein balance. Careful monitoring is necessary to ensure a regimen which maintains or improves body protein composition. Preliminary data exists which indicates that careful nutritional support may improve clinical outcome but more information is needed to recommend a universal approach.