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British Journal of Anaesthesia, 2000, Vol. 85, No. 2 185-188
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia

Editorial

Editorial I

Metabolic support of critically ill patients: parenteral nutrition to immunonutrition

The adaptive metabolic changes that occur during starvation were described in detail over 30 years ago and are an excellent example of an integrated physiological response that conserves body protein and maintains normoglycaemia.1 Critically ill patients are often malnourished and then starved for several days whilst undergoing the hormonal, metabolic and inflammatory changes that are commonly referred to as the ‘stress response’.2 It seems intuitively obvious, therefore, that feeding these patients during the gross catabolic phase of their illness should be beneficial. For many years, the best route for nutritional support was not clear and it is only in the past decade that there has been general agreement that enteral feeding is the method of choice.3 However, some patients do not tolerate enteral feeding or do not obtain sufficient intake orally or enterally to meet their nutritional needs. Total parenteral nutrition (TPN) may be used in these patients either as . . . [Full Text of this Article]

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