Metabolic stress

Critical illness is associated with a condition of catabolic stress, a systemic inflammatory response and complications that increase infectious morbidity, multi-organ dysfunction, the duration of hospitalisation and mortality.

Nutritional intervention must be carefully planned and considered on a level with any other therapy. All critically ill patients remaining more than 48 hours in the ICU must be regarded as vulnerable to malnutrition.

The guidelines on clinical nutrition in intensive care units published by the European Society for Clinical Nutrition and Metabolism (ESPEN) make the following recommendations:

• Nutritional therapy should be considered for all ICU patients, especially those who will remain for more than 48 hours
• If oral intake is not possible, enteral nutrition (tube feeding) should occur early (within 48 hours) in critical adult patients
• Proteins: 3g per kg per day, administered progressively.
• Enteral formulas enriched with omega-3 can be administered to the critical patient.

The purpose of nutritional support in the critically ill patient is to provide external fuel to:

• Preserve lean mass
• Reduce the metabolic response to stress
• Prevent oxidative cellular lesions
• Regulate the inflammatory response
• Regulate the immune system response

Enteral nutrition is seen as a proactive therapeutic strategy that can lessen the seriousness of the illness, reduce complications and the patient’s stay in the hospital’s ICU and produce a positive impact on patient recovery. Improvement in the evolution of the critically ill patient can be achieved through early enteral nutrition thanks to proper delivery of macro- and micro-nutrients and standardised glycaemic controls.