Nilesh M. Mehta, M.D.
N Engl J Med 2016; 374:1190-1192 March 24, 2016
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Adequate nutrient delivery may help to offset the catabolic burden imposed by critical illness, preventing nutritional deterioration and improving outcomes. However, questions regarding the most appropriate dose of macronutrients, the route of delivery, and particularly the timing of supplemental parenteral nutrition in critically ill children remain unanswered (Areas of Consensus and Controversy in Critical Care Nutrition for Children.). Enteral nutrition is preferable in patients with a functioning gut but may not always be feasible. Intestinal failure was incompatible with life until the 1960s, when the development of stable intravenous amino acid solutions and lipid emulsions allowed the administration of life-sustaining nourishment through the parenteral route.1 Parenteral nutrition was subsequently extended to critically ill patients when enteral nutrition was insufficient or contraindicated. As awareness of the unintended side effects of parenteral nutrition has increased, patient selection and the timing of administration are being investigated and the optimization of enteral nutrition emphasized.2