Nutrition support in the acutely ventilated patient.
Although the nutrition support literature is limited and therefore does not provide robust evidence to promote grade A or strong recommendations, there is a "signal" from all of these studies taken a a whole that critically ill patients may benefit from nutritional manipulation. The acutely ventilated patient that is likely to still be intubated by day three is a classic example of the critically ill patient who has the potential to achieve positive outcomes with nutritional support. Initiating nutrition support early improves the chances of benefit. However, nutrition cannot be provided in a vacuum. It is only one part of a multitude of treatments and therapies that must be optimally applied by a multidisciplinary team of professionals dedicated to the care of ICU patients. The exact makeup of the enteral (or parenteral) formula that is most likely to improve survival is unclear. More research is needed. Further study may demonstrate the possibility for nutritional manipulation to be one of the most important treatments physicians can offer to critically ill ventilated patients. Nutrition may have as much survival benefit as activated protein C, a drug costing over $7000 per course of therapy. No longer can it be said that nutrition makes no difference.
Oltermann
Mark H
MH
Department of Internal Medicine, Division of Critical Care, John Peter Smith Hospital, 1500 South Main Street, Fort Worth, TX 76104, USA. molterma@jpshealth.org
D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D009102:Multiple Organ Failure; D018529:Nutritional Support; D012122:Ventilators, Mechanical