To highlight the recent developments in nutritional support for critically ill patients.
Increasing data support the benefits of early initiation of enteral nutrition, with improvements in small intestinal absorption and clinical outcomes. In contrast to the previous belief, recent data suggest caloric administration of greater than 65–70% of daily requirement is associated with poorer clinical outcomes, especially when supplemental parenteral nutrition is used to increase the amount of caloric delivery. The role of supplementary micronutrients and anti-inflammatory lipids has been further evaluated but remains inconclusive, and is not currently recommended.
Together, current findings indicate that intragastric enteral nutrition should be initiated within 24 h of admission to ICU and supplementary parenteral nutrition should be avoided. Future research should aim to clarify the optimal energy delivery for best clinical outcomes, and the role of small intestinal function and its flora in nutritional care and clinical outcomes.
aDepartment of Gastroenterology and Hepatology, Royal Adelaide Hospital
bDiscipline of Medicine, School of Medicine, University of Adelaide
cDepartment of Critical Care Services, Royal Adelaide Hospital
dDiscipline of Acute Care Medicine, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
Correspondence to Dr Nam Q. Nguyen, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Tel: +61 8 8222 5207; fax: +61 8 8222 5885; e-mail: email@example.com