Nutritional support of intensive care patients

Although the ICU is mainly concerned with the function of "vital organs" nutritional support should also have an important part in the treatment of critically ill patients. Intensivists must define the time-point, application route, and the quality of the nutrition to be applied. Guidelines on enteral and parenteral nutrition in intensive care medicine offer evidence-based recommendations. The aims of the dietary support consist in the prevention and therapy of malnutrition and metabolic complications. Moreover, immunomodulatory approaches have a positive influence on immunological function and metabolic disorders. First, a registration of the nutritional status is necessary. Nutritional therapy must be adapted to the course of illness, which is done with the help of simple clinical and laboratory parameters. The daily calorie intake is approximately 20-30 kcal/kg body mass. Several studies reported that a reduction of complications is achieved as a result of an early onset of enteral nutrition. In addition to the physiological route of ingestion, enteral nutrition should be the first choice. Parenteral nutrition presents a secondary option, if the enteral route fails to maintain a sufficient calorie supply. The components of parenteral nutrition are carbohydrates, fatty acids and amino acids, supplemented by vitamins and electrolytes. The use of mixed bags is safe and reasonable. A good cooperation with the nursing staff is essential for nutritional support to be successful.