The healthcare professionals often underestimate the nutritional needs of the patients who are critically ill. Moreover, the initiation of nutritional therapy is often delayed in these patients. In the critically ill patient, nutritional status plays a key role in recovery. The extent of muscle wasting and weight loss in the ICU is inversely correlated with long-term survival. However, because conventional parenteral nutritional therapy of malnourished critically ill patients has not been demonstrated to produce anabolism, blunting of the catabolic state may be the more effective strategy. Over the top of that malnutrition in the critically ill patients have been associated with increased mortality, morbidity, and length of stay, which may be correlated to increased dependency of mechanical ventilation, enhanced rates of infection, and impairment of wound healing. Therefore, to determine the evidence in this area of care, it would be prudent to critically analyse the research findings which could justify the indications and contraindications of nutritional therapy in these patients. ...
Concomitantly, there is an increase globulin synthesis as a part of acute phase response. Metabolically, there is noted to be increased gluconeogenesis along with reduced serum iron and zinc levels and increased copper and ceruloplasmin levels. These changes lead to fever and an associated negative nitrogen balance. There is protein breakdown invariably in all patients. There is evidence that critically ill adult patients may lose about 16-20 g of nitrogen, which are supposed to be excreted in the form of urea, which in normal individuals are about 10-12 g/d. Many acutely ill patients have septic complications, and in some of them, the nitrogen loss may account for up to 24 g of urinary urea nitrogen daily. The nutritional implications of these facts become very significant since with the loss of 1 g of urinary urea nitrogen, the nitrogen content in 6.25 g of protein is loss, which is equivalent to approximately 1 oz of lean body mass. As one can calculate, the loss of 16 g of nitrogen as urinary urea is therefore equal to the loss of about 1 lb of skeletal muscle or lean body mass per day (Doig et al., 2008).
Nutritional supplementation, hence, bears an important meaning in the management of patients who are critically ill. Studies have indicated that initiation of nutritional supportive treatments in critically ill patients within 48 to 72 hours of admission has at least three important outcomes. These are improved clinical outcomes, lower rates of infectious complications, and shorter duration of hospital stay. The route of administration of nutritional supports to these patients has also important influences over clinical outcomes. Evidence indicates that enteral nutrition is favorable over parenteral