Intravenous literature: McDougall, M. (2012) Nutritional support in the critically ill. Anaesthesia and Intensive Care Medicine. 13(4), p.158-160.
Nutritional support in intensive care requires a multidisciplinary approach involving intensivists, surgeons, nurses, dietitians and pharmacists. Many critically ill patients are already malnourished on admission, either due to pre-existing disease, the acute illness or alcohol and drug use. Challenges include identifying malnourished patients, preventing refeeding syndrome, placing feeding tubes and lines, preventing and treating complications, calculating calorific requirements, maintaining ongoing feeding during prolonged critical illness and choosing the most appropriate feed for each patient. The metabolic derangements of critical illness are such that patients lose muscle bulk despite adequate nutrition, but its provision is essential to minimize the adverse effects of catabolism.