Abstract

Nutrition plays a vital role in the management of critically ill patients, as it significantly impacts outcomes, recovery, and survival. However, determining the appropriate quantity and composition of nutritional support remains a challenge. Both underfeeding and overfeeding can result in adverse outcomes, such as impaired immune function, increased infection risk, delayed wound healing, and prolonged mechanical ventilation. The metabolic response to critical illness is dynamic, influenced by factors such as disease severity, comorbidities, and the patient’s baseline nutritional status.

Caloric needs vary over time and require careful assessment using tools like indirect calorimetry or predictive equations. Early initiation of enteral nutrition is preferred, as it preserves gut integrity and reduces complications, while parenteral nutrition is reserved for cases where enteral feeding is not feasible. Macronutrient distribution must balance protein for muscle preservation, carbohydrates for energy, and lipids for immune modulation. Micronutrients and electrolytes also play essential roles but need individualization.

Emerging evidence suggests a “trophic feeding” approach in the initial phase of critical illness, followed by gradual advancement as metabolic stability improves. Close monitoring of nutritional interventions, including markers of tolerance and adequacy, is crucial for optimizing outcomes. Current guidelines, based on consensus and evidence, highlights the need for personalized, dynamic nutrition strategies in critical care and emphasizes the importance of multidisciplinary collaboration to determine how much nutrition is “good” for each patient.