Abstract
The metabolic response to stress and injury results in increased catabolism, leading to insulin resistance and protein breakdown. Surgical, trauma, and burn patients are especially susceptible to acute protein-calorie malnutrition. Early diagnosis and prompt correction are paramount with enteral nutrition administered when possible. Total parenteral nutrition should be initiated whenever enteral nutrition is impossible or inadequate. Careful reassessment of nutritional requirements should occur frequently, as the patient’s energy and protein requirements are in flux during the early phases of injury. Nutritional support is an integral part of trauma and critical care management, and its role has undergone dramatic evolution as we have gained a more comprehensive understanding of the complex inflammatory and metabolic pathways that accompany surgical stress. The manipulation of this stress response and its inherent catabolic reaction is a primary focus of emerging nutritional therapies.