Key messages

• The nutritional and metabolic changes which occur in critical illness are driven by any combination of lack of nutrient intake (starvation), the endocrine/mediator response to the 'stress' of critical illness, and physiological insult to the gastrointestinal tract.

• The metabolic response to critical illness is typified by catabolism, protein loss, and immunosuppression.

• Nutritional support of the critically ill patient should supply raw material for protein anabolism, wound healing, and organ repair, supply energy and other substances needed to maintain cellular function, and, if possible, attenuate harmful aspects of the metabolic response.

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