Our understanding of the effects of total parenteral nutrition in critical illness has been refined over the past year. The importance of not overfeeding patients has been highlighted. The effects of lipid emulsions containing medium-chain triglycerides, compared with standard ones, have been investigated and show, in particular, changes in platelet membrane fatty acid composition. Although data on clinical end-points are lacking, this is likely to be a fruitful area of further research. The importance of providing enteral support, if at all possible, has been further underlined by its beneficial effects on bile composition in the intensive care setting. Finally, critical illness has been shown to be, in general, a contraindication to growth hormone therapy.
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