Controversies, principles and essentials of enteral and parenteral nutrition in critically ill-patients

Nutritional management in critically ill-patients is always a challenging task as malnutrition can have a direct impact on the prognosis. Besides assessing for nutritional requirement, the underlying severe illness and co-morbidities have to be given due consideration. Nutritional assessment has to be individualized, and nutritional plan should be formulated by involving a dedicated nutritionist. Early initiation of nutrition definitely improves the outcome in critically ill patients. Facts and principles of enteral and parenteral nutrition must be disseminated among all physicians and nursing staff working in intensive care units. Majority of old controversies related to parenteral and enteral nutrition have been settled with the intervention of various national and international committees such as Alliance and Espen. Nutritional disorders such as malnutrition, overfeeding and negative energy balance are highly associated with increased morbidity and mortality. Enteral nutrition though always preferred can always be supplemented with parenteral nutrition so as to optimize nutrition and energy status in critically ill patients.