Above and Beyond: When Clinical Guidelines for Nutrition Support Fall Short

Adequate nutrition support is an important intervention for critically ill patients posttransplant and can result in desirable outcomes. However, energy requirements of these patients are uncertain and debatable, and cannot always be measured with indirect calorimetry. Even less consensus is available for those who languish in the intensive care unit and develop chronic critical illness (CCI). Individuals with CCI are at high risk for malnutrition due to hypermetabolism, wound healing requirements, and loss of lean body mass. This case study presents the nutritional management of a severely malnourished, multiorgan transplant recipient with CCI.