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Parenteral nutrition in adult intensive care.

A healthy person deprived of food will starve to death in approximately 2 months; severe trauma or major surgery reduce that time to about one month. A loss of more than about 12% of total body nitrogen or ofmore than 33% ofbody weight is generally fatal. Lesser degrees of protein/calorie malnutrition, via respiratory muscle weakness, reduced hypoxic drive and decreased tissue oxygenation, contribute to postoperative pneumonia and difficulty in weaning from ventilators. Nutritional impairment of cardiac function and frank cardiac failure also occur. Bacteraemia from increased gastrointestinal permeability, decreased resistance to infection, and impaired wound and bone healing are concurrently disadvantageous. Although critically ill patients should benefit from nutritional support, the ideal constituents, timing and routes of intervention remain to be established. There is a dearth of major trials of intravenous nutrition in the critically ill, and inadequate appreciation of the changing metabolic status of patients at different stages of illness. In combination with the more obviously varying requirements between patients, these factors have resulted in discordant advice on nutritional intervention, and often in subsequent suboptimal management. '12