<![CDATA[Personalized nutrition in the intensive care unit (ICU) has evolved from traditional caloric replacement strategies toward a multidimensional, biology-driven model that incorporates microbiome ecology and metabolomic signatures. Critical illness induces profound alterations in gut microbial diversity, metabolite production, epithelial integrity, and systemic immune responses, all of which interact with nutritional therapies. Parallel advances in metabolomics offer real-time insight into mitochondrial function, substrate utilization, and catabolic stress, providing a framework for phase-specific nutritional targets. This review synthesizes current evidence on ICU nutrition guidelines, recent randomized trials, and emerging multi-omics science to propose an integrated approach to personalized feeding. Emphasis is placed on early enteral nutrition, avoidance of early overfeeding, moderated protein delivery, and the selective use of supplemental parenteral nutrition, contextualized within microbiome-host metabolic interactions. Preliminary studies suggest that microbiome-guided and metabolomics-informed nutrition could reduce infection risk, optimize metabolic tolerance, and support organ recovery, but clinical translation requires rigorous validation.]]>
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