Practical nutritional management in the trauma intensive care unit.

Critically injured patients offer an exceptional challenge to intensivists. Pre-existing disease states complicate horrendous disruptions in normal anatomy and physiology. The hypermetabolic, catabolic response brought on by trauma, shock, or sepsis serves to reprioritize the normal nutritional homeostasis of the body. Appropriate nutritional support not only minimizes the wasting effects of hypermetabolism but potentially offers additional benefits. Studies of feeding routes, substrates, and timing suggest that adequate support may decrease infectious complications and modulate the metabolic response. Injured patients are a heterogenous group, making the definition of adequate support and interpretation of experimental findings difficult. Ultimately, most severely injured patients need directed nutritional support because of their inability to ingest nourishment by conventional means. This article emphasizes a practical approach to these patients.