Nutritional Support in Critically Ill Patients

The metabolic response to aggression corresponds to different reactions that form the basis of the body's adaptation to new context. These modifications concern specific metabolic aspects such as the maintenance of protein mass and/or the state of energy reserves. One of the main difficulties in optimizing metabolic support is to distinguish beneficial metabolic changes from those that are harmful to the body. In this context, therapeutic ambitions can be limited to a nutritional approach focusing on limiting the energy deficit, protein, and muscle losses. They can be more ambitious by trying to adapt the different needs from both a quantitative and qualitative point of view. According to the literature, limiting the energy deficit seems to be a major objective to achieve. Finally, trying to interfere with the metabolic response to aggression (immuno-modulation, pharmacological manipulations of metabolic pathways, etc.) represents the most elaborate degree of metabolic intervention but it is not possible to say that this objective is completely realistic, or even beneficial. Nutritional intakes should be integrated into the overall therapeutic management strategy. The optimal nutritional support response aims to "provide the metabolic means" for healing.