Metabolic and nutrition support in the chronic critical illness syndrome

Technological innovations in the ICU have led to artificially prolonged life, with an associated cost. Chronic critical illness (CCI) occurs in patients with prolonged mechanical ventilation and allostatic overload, and is associated with a discrete and consistent metabolic syndrome. Metabolic inter...

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Bibliographic Details
Published in:Respiratory care 2012-06, Vol.57 (6), p.958-978
Main Authors: Schulman, Rifka C, Mechanick, Jeffrey I
Format: Article
Language:English
Subjects:
Artificial respiration
Bone Diseases, Metabolic - therapy
Calcium, Dietary - administration & dosage
Calorimetry, Indirect
Care and treatment
Chronic Disease
Critical Care - methods
Critical Illness - therapy
Critically ill
Energy Metabolism
Enteral Nutrition
Health aspects
Humans
Hyperglycemia - prevention & control
Hypothalamo-Hypophyseal System - physiopathology
Nutrition Assessment
Nutritional aspects
Nutritional Support - methods
Patient outcomes
Syndrome
Vitamin D - administration & dosage
Wound Healing - physiology
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Summary:Technological innovations in the ICU have led to artificially prolonged life, with an associated cost. Chronic critical illness (CCI) occurs in patients with prolonged mechanical ventilation and allostatic overload, and is associated with a discrete and consistent metabolic syndrome. Metabolic interventions are extrapolated from clinical critical care research, scientific theory, and years of CCI patient care experience. Intensive metabolic support (IMS) is a multi-targeted approach consisting of tight glycemic control with intensive insulin therapy, early and adequate nutrition therapy, nutritional pharmacology, management of metabolic bone disease, and meticulous attention to other endocrine/metabolic derangements. Ideally, IMS should be under the supervision of a metabolic support consultative team. Further research specifically focused on the CCI population is needed to validate this current approach.
ISSN:0020-1324
1943-3654
DOI:10.4187/respcare.01620