Without doubt, in medicine as in life, one size does not fit all. We do not administer the same drug or dose to every patient at all times, so why then would we live under the illusion that we should give the same nutrition at all times in the continuum of critical illness?

We have long lived under the assumption that critical illness and trauma lead to a consistent early increase in metabolic/caloric need, the so-called “hypermetabolism” of critical illness. What if this is incorrect?

We need to consider basic metabolism and our historic understanding of starvation and recovery to employ targeted nutritional care for our critically ill patients.

If we are to optimize patient outcomes and start creating “survivors and not victims” we must realize that one-size nutrition and one calorie delivery “does not fit all”.

It is clear our patients’ nutritional needs change over the course of illness.

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