title: Critical Care Nutrition: Where's the Evidence?
abstract: The surgical critically ill patient is subject to a variable and complex metabolic response, which has detrimental effects on immunity, wound healing, and preservation of lean body muscle. The concept of nutrition support has evolved into nutrition therapy, whereby the primary objectives are to prevent oxidative cell injury, modulate the immune response, and attenuate the metabolic response. This review outlines the metabolic response to critical illness, describes nutritional risk; reviews the evidence for the role, dose, and timing of enteral and parenteral nutrition, and reviews the evidence for immunonutrition in the surgical intensive care unit.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA.
authors.forename: Jayshil J
authors.initials: JJ
authors.lastname: Patel
authors.affiliation: Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Hurt
authors.affiliation: Division of Gastroenterology, University of Louisville, 2301 South 3rd Street, Louisville, KY 40208, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McClave
authors.affiliation: Division of General Surgery, Department of Surgery, Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA. Electronic address: martindr@ohsu.edu.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Martindale
mesh_terms: D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D009748:Nutrition Disorders / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D044623:Nutrition Therapy / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000009:adverse effects
keywords: Critical care nutrition; Enteral nutrition; Metabolic stress response; Nutritional risk; Parenteral nutrition; Permissive underfeeding; Supplemental parenteral nutrition; Trophic feeding