Abstract

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.

Links

Publisher Full Text

Authors

Schulman RC, Mechanick JI

Institution

Division of Endocrinology, Diabetes, and Bone Diseases, Mount Sinai School of Medicine, New York, New York 10128, USA.

Source

Respiratory care 57:6 2012 Jun pg 958-77; discussion 977-8

MeSH

Bone Diseases, Metabolic
Calcium, Dietary
Calorimetry, Indirect
Chronic Disease
Critical Care
Critical Illness
Energy Metabolism
Enteral Nutrition
Humans
Hyperglycemia
Hypothalamo-Hypophyseal System
Intensive Care
Nutrition Assessment
Nutritional Support
Syndrome
Vitamin D
Wound Healing

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22663970