Nutrition during critical illness and sepsis.

The requirements for nutrient substrates are altered in patients with infection and critical illness. Parenteral and enteral nutritional support are indicated in septic patients to preserve lean body mass and support metabolic processes while appropriate anti-infective therapy is administered. In general, such patients require greater amounts of protein and fewer calories than normal patients. Enteral nutrition in septic patients has been demonstrated to be safe and well tolerated if begun immediately after the onset of infection or after injury. The salutary effect of enteral nutrition on the gastrointestinal tract has been shown to enable severely injured patients to have a lower frequency of infectious complications than similar patients fed parenterally. A new enteral formula fortified with arginine, nucleotides, and fish oil has been demonstrated to reduce hospital stay and to reduce complications in patients who are fed for > or = 7 days when compared with conventional formula. The increased use of early enteral nutrition and special nutrient formulas has the potential to reduce hospital length of stay, complications, and the cost of care if used appropriately.