In our daily practice, we aim to improve patients' outcome by providing all sorts of treatment modalities. However, are we really creating suvivors and not victims? Studies have shown that patients discharged from ICU may suffer from post ICU syndrome, in which patients will be manifested as impairment in physical, cognitive and mental health. Apart from ABCDEF bundle (A-assess, prevent and manage pain; B-both spontaneous awakening and breathing trials; C-choice of medication management; D-delirium; E-early mobility and exercise; F-family engagement and empowerment), appropriate nutrition therapy can improve patients' outcome.
There are a lot of convertrosies in the field of critical care nutrition, but the basic concept is to start early when the patient has adequately resuscitated, not to give too little or too much. We should bear in mind that every patient is different and one size does not fit all. Therefore, when we are considering nutrition therapy to our patients, we should provide assessment for individual patient.
 We will encounter different obstacles during the journey of nutrition therapy. It is important for us to identify those obstacles and try to overcome them with the aim to reduce interruptions during nutrition therapy. It is also a time to review the role of gastric residual volume; which is a tradition to guide enteral feeding tolerance, and the establishment of nutrition therapy team (NTT) should be considered.
Our local position statement for critical care nutrition is currently under construction, with the support from Hong Kong Society of Critical Care Medicine (HKSCCM) and Hong Kong Society of Parenteral and Enteral Nutrition (HKSPEN). Hopefully this position statement can serve as a guide of nutrition therapy for critically ill patients in our locality.

In resource limited regions, many critically ill patients receive invasive mechanical ventilation in a non-ICU/designated high-care environment. In Hong Kong there are different models-of-care provided for this group of patients in general wards: unstructured care in general wards, or a designated ward with either a designated ventilation team, or a supporting team from ICU. We conducted a prospective observational cohort study to evaluate outcomes, and whether different models-of-care are associated with mortality.
Data from 7 hospitals, from January to April 2016, was recorded. Hospital mortality, and time from study recruitment to death, or 90 days, was recorded. Standardized mortality ratio (SMR) using the Mortality Probability Model (MPM III) was calculated. Cox regression was used to estimate the hazard ratio (HR, with 95% CI) for comparing mortality between models-of-care, taking hospitals clustered within models-of-care into account.
We excluded 185 patients either undergoing limitation-of- life-support within 24 hours, or being cared in one hospital adopting a different model-of-care (only 15 eligible patients), the analysis was based on 285 patients, with 3 different models-of-care:
Model A: Designated ward/no designated ventilation team/supporting team from ICU (1 hospital)
Model B: Designated ward/designated ventilation team/no supporting team from ICU (2 hospitals)
Model C: No designated ward/no designated team/no supporting team from ICU (3 hospitals)
Of 285 patients, 173 died (61%, 95% CI: 55%-66%) in hospital, and 187 (66%, 95% CI: 60%-71%) had died within 90 days after intubation. Overall SMR was 1.82 (95% CI:1.56-2.11). In the cox regression model, stratified by mechanical ventilation duration (< 48h vs ≥48h), and adjusted for MPM III score and causes for respiratory failure, there was a significant difference between models-of-care (P< 0.001). Discrimination was acceptable (c-statistic=0.71). A designated ward, and a ventilation team or supporting team from ICU may improve survival.

As the survival rate in critically ill patients improves, the morbidities and the long-term complications of the intensive care unit (ICU) survivors are increasingly recognized. Among these chronic morbidities, Intensive Care Unit-acquired weakness (ICUAW) is one of the commonest. It is defined by the American Thoracic Society as a syndrome of generalized limb weakness that develops while a patient is critically ill without alternative explanation other than the critical illness itself. The incidence of ICUAW was reported to be 25.3% to 100%. ICUAW is associated with prolonged mechanical ventilation and ICU length of stay (LOS), as well as high ICU, hospital, and 1-year mortality rates, and persistent functional disability even up to 5 years. Despite there are growing evidence that early mobilization may improve the outcomes of critically ill patients, the practice among varies ICU are very variable. This is related to certain organization factor and practical barrier. Even so, it is worthwhile for us to identify and overcome the barriers to early mobilization.