The evolutionary role of nutrition and metabolic support in critical illness

Critical Care Clinics
Nicolas Mongardon, Mervyn Singer

Abstract

Maintenance of nutritional status is particularly challenging during critical illness. There is a common perception of a race against the clock to adequately feed the patient to prevent or minimize the sometimes catastrophic muscle wasting and general catabolic state that can result in the patient's deterioration. However, the course of critical illness may be separated into 3 phases, each with highly differing metabolic needs. The initial phase, in which the body attempts to fight the acute insult, is generally hypermetabolic. When the body fails to overcome the insult, it enters into a second phase, which is akin to hibernation. This stage is characterized by a functional metabolic shutdown triggered either by a lack of adequate energy supply or perhaps by the direct switching off of metabolism to spare excess use of a dwindling substrate and energy resource. Those strong enough to survive this phase enter into a period of recovery during which appetite returns, anabolism recommences, and organ function is restored. Nutrition should perhaps closely follow these nonlinear requirements, so as to avoid deleterious under- or overnutrition during the appropriate phase. This approach fits a teleologic argument that enabled many sic...Continue Reading

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Citations

Mar 5, 2013·Medizinische Klinik, Intensivmedizin und Notfallmedizin·G ElkeUNKNOWN German Competence Network Sepsis (SepNet)
Dec 16, 2010·Current Opinion in Clinical Nutrition and Metabolic Care·Gerd G GauglitzMarc G Jeschke
Jul 29, 2015·Intensive Care Medicine Experimental·Marie-Angélique CazalisGuillaume Monneret
Jan 31, 2015·Current Opinion in Clinical Nutrition and Metabolic Care·Gunnar ElkeNorbert Weiler
Jun 9, 2016·Current Opinion in Critical Care·Mile StanojcicMarc G Jeschke
Jun 29, 2014·The Journal of Immunology : Official Journal of the American Association of Immunologists·Mingfang LuRobert S Munford
Mar 19, 2016·Journal of Applied Physiology·Monique T FonsecaAlexandre A Steiner

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