Biology-based nutritional support of critically ill and injured patients

Background: Critical illness and tissue injury initiate a complex series of rapid homeostatic events in an attempt to prevent ongoing tissue damage and to activate the repair process. Classically, inflammation has been recognized as the hallmark of the homeostatic response. But more recently, attention has been focused on defining the response at the cellular, metabolic, and molecular levels. Methods: Review of current literature on immunomodulating nutrition support of critically ill and injured patients. Results: There is mounting evidence regarding metabolic changes in critically ill and injured patients and their need for key nutrients and special substrates. As we refine and further define nutritional support for critically ill patients, it is imperative that we continue to pursue a deeper understanding of this field. Specifically, in order to provide timely and disease-directed nutritional support, we must elucidate the most crucial changes in acute phase proteins, cytokines, and other biochemical indices. Conclusions: It has become clear that no one formula fits all. Rather, nutritional support must be principally based on each individual patient's disease and condition.