Nutritional support in the mechanically ventilated patient.

In summary, nutritional management of the intubated patient requires several decision steps. Nutritional support should be strongly considered if the patient has evidence of malnutrition by nutritional assessment or has a high likelihood of becoming malnourished by virtue of a severe, prolonged critical illness. Nutrition can be administered enterally if good gut function exists or parenterally in patients unable to tolerate enteral feeding. Nutritional goals in the intensive care unit include maintenance of body weight and lean body mass. Proper nutritional therapy includes assessment of adequate caloric requirements as well as appropriate protein, carbohydrate, and fat composition of the nutritional support. Monitoring the efficacy of nutritional therapy includes evaluating nitrogen balance. Complications of both enteral and parenteral therapy exist. Nutritional therapy is but one link in the chain of therapeutic endeavors given a critically ill patient but, as with all other treatment modalities, requires knowledge of basic fundamentals.