During the last decade, there has been a major conceptual shift in thinking about artificial nutrition provided to critically ill patients. Because of its modulating effect on pathophysiology and emerging evidence about potential effects on clinical outcomes, nutrition is now considered “therapy” and not simply “supportive care.” For example, arginine-supplemented diets are associated with reduced infections and lengths of hospital stay in patients undergoing elective operations,1 glutamine-supplemented parenteral nutrition is associated with reduced infection and mortality in critically ill patients,2 and antioxidant supplementation is associated with reduced mortality among critically ill patients with systemic inflammation.3 The new model of “pharmaconutrition” calls for trials examining the dose, route, timing, and duration of each intervention, focusing on whether the intervention is designed to restore an existing deficiency, reduce ongoing loss of an expended substrate, and/or provide supratherapeutic exposure.
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