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Overfeeding caused by the inaccurate estimation of energy might be one of the most important reasons leading to unsatisfactory outcomes of nutritional support, especially for Parental Nutrition (PN). The current method of determining calorie needs by energy expenditure (EE), either measured by indirect calorimetry (IC) or equations, might not accurately represent the actual energy requirements of critically ill patients, especially in the acute phase. Nutrition protocols based on the measurement of time might not be effective. Research on the real-time metabolic status and the actual energy requirements of the patients, as well as more individualized nutrition therapy, is required. Central regulation, especially those involving hypothalamic pathways, is an effective solution for the current dilemma.

Nutritional support in the acute phase of critical illness—how to break the dilemma