Nutritional support of the septic patient.

Nutrition and metabolic support is just one of many weapons at the clinician's disposal in the battle against infection. Much has been learned in the past several decades concerning the host's response to infection and the competition among substrates during health and disease. Despite these advances, we still are remarkably ineffective at preventing the muscle wasting that accompanies sepsis and other chronic catabolic conditions. This likely is the result of our lack of understanding concerning the molecular mechanisms responsible for changes in protein metabolism. It is anticipated that the optimal or preferred mixture of glucose, fat, and protein will be better defined in the future, and that new supplements (e.g., MCTs, amino acids, growth factors, antioxidants) will prove beneficial, so the protein-catabolic response to sepsis can be ameliorated and patient outcome improved. Until that time, nutritional interventions should be initiated early in the septic episode and be assessed and altered frequently. Specific guidelines for nutritional support are presented in Table 3.