重症患者における栄養管理

Nutritional management is one of very important therapeutic intervention for every kind of patients. In critically ill patients, metabolic state varies according to the severity of injury or disease. It is crucial to give appropriate calories to overcome their stress. Recently, it is reported that hyperalimentation should be avoided in acute phase of critically illness, which is generally agreed as permissive underfeeding. It is also necessary to supply those patients with enough amount of protein because protein deficiency decrease the lean body mass（LBM）. Loss of LBM induce organ dysfunction as well as immunodeficiency which lead to patient mortality. Enteral nutrition is superior to parenteral nutrition. Intestine plays an important role as endocrine and immune organ. Bacterial translocation, which is one of the most important causes of sepsis in critically ill patients, is prevented by enteral feeding. We should start enteral feeding as early as possible and make the most of intestinal function.