Feed the gut, feed early and with the right stuff, but do not forget total parenteral nutrition
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EDITORIAL
Feed the gut, feed early and with the right stuff, but do not forget total parenteral nutrition R. Latifi • S. Uranues
Received: 27 October 2012 / Accepted: 30 January 2013 / Published online: 5 March 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Our recent article published in the European Journal of Trauma and Emergency Surgery [1] on nutrition support was widely downloaded by our readers, which gave the editors of the journal indications that there is a need for a focused issue on the nutrition support of trauma and critically ill patients. Professor Uranues and myself asked expert clinicians from different parts of the world to put together a number of articles that will shed light on the current principles and practices of the nutrition support of critically ill and injured patients. What we received are outstanding reviews of current evidence that we hope will serve clinicians around the world and, in particular, our trauma community to provide better care to our injured and critically ill patients. While nutrition support has changed dramatically in the recent two to three decades, it is imperative that, in order to improve our practice of nutritional support for trauma and critically ill patients, we should continue to pursue further understanding of their metabolism, energy requirements and specific requirements of each nutrient, and not rely on old dogma and guidelines established by experts’ opinions and semi-quasi data. Specifically, we need to continue to challenge the current understanding of nutritional science, the biology of R. Latifi (&) Department of Surgery, University of Arizona, Tucson, AZ, USA e-mail: [email protected] R. Latifi Trauma Services, Hamad General Hospital, Doha, Qatar S. Uranues Section for Surgical Research, Clinical Division of General Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria e-mail: [email protected]
nutrients and the interaction of these nutrients with trauma, injury and critical illness, and how to further advance timely and disease-directed nutritional support. In the meantime, we need to provide nutritional support to critically ill or injured patients early and we need to do it right [2], and we should tailor nutritional formulas based on the content of the nutrient compositions [3–5]. In the first article of this focus, Afifi et al. clearly demonstrate the evidence of significant metabolic changes that occur in critically ill and injured patients, and the need for supplementing key nutrients or special substrates to these patients in order to minimise the effect of trauma or critical illness. It has become obvious to all clinicians caring for these sick patients that one formula no longer fits all, as demonstrated by Yeah and Velmahos. To this end, there has been a significant paradigm shift in regard to selecting the appropriate nutritional strategy for critically ill and injured patients. In doing so, the nutrition support of patients with a particular disease is no longer regarde
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