One needn't have a medical license or years of training as a clinician to understand the simple importance of nutrition. There are numerous clichés that embody this very sentiment ("An apple a day keeps the doctor away..."; "Chicken soup will heal what ails you...") What is commonly accepted is that proper nutrition can not only guard against ailments, but aid in the rebuilding of muscle, and help to restore energy and strength in recovery from illness.
Of course, in practice, in the ICU, treating critically ill patients, this premise becomes much more complex. How should nutrition be given? What type? How much? How should we base our guidelines? Over the years, much consideration has been given to this broad topic of nutrition in intensive care, and the accepted guidelines have changed with the tides.
In this issue, Dr. Martindale tackles the validity of the pharmaconutrition evolution and Dr. Sanchez Nava underlines the importance of utilising strict protocols for success with enteral nutrition in ICU patients. As many nutrition questions arise with regards to specific groups of critically ill patients, we have included an article from Dr. Hiesmayr on managing the nutritional challenges of obese patients as well as an interesting focus on nutritional support of obstetric patients contributed by a team of nutritionists.
It is difficult to believe that it has been more than a year since the outbreak of the AH1N1 virus in Mexico and subsequent global pandemic. Dr. Vasquez de Anda marks the occasion with some reflection on what organisational changes have been made since the crisis, and those that are necessitated in anticipation of a future virus with epidemic potential. Also in our Matrix, we feature an engrossing discussion of balancing the risk and benefits of utilising drug eluting stents by Dr. Rodriguez of Argentina.
Germany takes centre stage in this edition of the journal with an extensive overview of its healthcare system; a focus on the specialised nature of neurointensive care units and; in our Management section, the introduction of a unique concept in the structural organisation of intensive care; aptly named "ICU Outside the Box", which is currently being utilised within a German hospital.
Teamwork is oft-touted as a catchword of our times. Within our units, the idea holds a great deal of merit as it is often a multidisciplinary group of care providers who must merge diagnoses, treatment ideas and daily decisions for our patients. In our Viewpoints section, Dr. Pelosi highlights the importance of this approach within any management strategy and further, as ESA President, he enlightens us on the upcoming mandates of the society in the interest of improving patient safety.
The importance of nutrition within critical care is accepted, as are some basic guidelines. As the field expands to incorporate more by way of study into additives and pharmaconutrition and is further driven by clinicians' call to improve patient outcomes and lower length of stay; more clarity and precise protocols will assuredly become mainstream.