[ Vol. 8 No. 3 ] (September - December 2007 )
Current trends in nutritional support in critical illness: from bench to bedside

 Dr Andrew Davies
President AuSPEN, Alfred Hospital, Melbourne, Australia

Nutrition support (NS) improves clinical outcomes in the critically ill and our understanding of its effects has advanced significantly over the last few years. Several recently published evidence-based guidelines are extremely useful in assisting clinicians to provide NS. The predominant current recommendations for ICU patients are that (1) enteral nutrition (EN) should be preferred to parenteral nutrition (PN) unless there is a major gut condition which will delay commencement of EN; and (2) nasogastric feeding should begin within 24 hours, but if intolerance develops, small bowel feeding or promotility drugs (erythromycin or metoclopramide) should be attempted. Most of the recent trends revolve around the composition of the EN formula leading to the view that the term pharmaconutrition should replace the term nutritional support. EN should not routinely be supplemented with arginine or glutamine, but recent evidence suggests a formula of fish oil, borage oil and antioxidants should be used if the patient has acute lung injury or sepsis. PN should be supplemented with glutamine and the PN prescription should be limited in energy to avoid hyperglycaemia. Whether using EN or PN, most patients should receive intravenous selenium and may also need zinc and copper supplementation for their antioxidant effects.

The 12th PENSA Congress
October 18-20 2007
Century Park Hotel, Manila, Philippines
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