Our discussion today is with Professor David Bihari,  a senior intensive care physician at Prince of Wales Hospital in Sydney and Lismore Base hospital. A graduate in Medical Sciences from Corpus Christi College, Cambridge and University College Hospital, London , David first developed an interest in the relatively new specialty of intensive care medicine whilst working as a senior house officer on the cardiothoracic and intensive care units at the Middlesex Hospital. After a brief stay in Australia in 1987 as a staff specialist at Sydney’s Royal North Shore Hospital David was subsequently appointed as director of intensive care at Guy’s Hospital, London. On returning to Australia in 1995 David took up a role  at St. George Hospital in Sydney with a conjoint appointment as an associate professor in the University of New South Wales.

David has extensive experience in the management of both enteral and parenteral nutrition in critically ill patients. In today’s discussion David elaborates on his approach to the care of the ICU patient, with the key initial key goals of resuscitation and stabilisation in mind. David explains the importance of organ perfusion and discusses interventions to support a functioning immune system. A  carefully considered nutrition regime aimed at meeting both protein and energy goals should be developed within 48 hours post admission. The discussion also looks at the different types of nutrition options, managing flow rates and the role of future studies and training to ensure nutrition therapy is prioritised as a key intervention in the management of critically ill patients.