Alimentation with carbohydrate in the severely III and injured: Historical perspectives

The clinical use of nutrition has undergone dramatic changes since the advent of modern medicine at the turn of the 19th and 20th centuries. However, it was not until over halfway through the century that the first breakthrough occurred that dramatically affected clinical practice. The advent of TPN made the provision of nutrition possible to all patients regardless of the condition of the gut. These new techniques brought nutrition in the severely ill and injured into focus, and other less invasive and less expensive methods of feeding using the gut were developed soon thereafter. Some of the questions posed by the first investigators, however, are not yet solved: What is the best caloric substrate to use? When? How much should be given? How? It is the challenge of our generation to answer these questions, not only to avoid the complications of malnutrition in our critically ill patients, but also for use as therapy to improve outcomes.