Metabolic and nutrition support in the chronic critical illness syndrome

• 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
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.01620

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.