The nutritional and metabolic support of heart failure in the intensive care unit.
OBJECTIVE
Heart failure and cardiovascular disease are common causes of morbidity and mortality, contributing to many ICU admissions. Nutritional deficiencies have been associated with the development and worsening of chronic heart failure. Nutritional and metabolic support may improve outcomes in critically ill patients with heart failure. This review analyzes the role of this support in the acute care setting of the ICU.


RESULTS
Cardiac cachexia is a complex pathophysiologic process. It is characterized by inflammation and anabolic-catabolic imbalance. Nutritional supplements containing selenium, vitamins and antioxidants may provide needed support to the failing myocardium. Evidence shows that there is utility in intensive insulin therapy in the critically ill. Finally, there is an emerging metabolic role for HMG-CoA reductase inhibition, or statin therapy, in the treatment of heart failure.


CONCLUSIONS
Shifting the metabolic milieu from catabolic to anabolic, reducing free radicals, and quieting inflammation in addition to caloric supplementation may be the key to nutritional support in the heart failure patient. Tight glycemic control with intensive insulin therapy plays an expanding role in the care of the critically ill. Glucose-insulin-potassium therapy probably does not improve the condition of the patient with heart failure or acute myocardial infarction.
Meltzer
Joseph S
JS
Division of Critical Care Medicine, Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA. jm2650@columbia.edu
Moitra
Vivek K
VK
D000208:Acute Disease; D002318:Cardiovascular Diseases / Q000378:metabolism / Q000628:therapy; D005947:Glucose / Q000378:metabolism; D006333:Heart Failure / Q000378:metabolism* / Q000628:therapy*; D006801:Humans; D007328:Insulin / Q000378:metabolism / Q000627:therapeutic use; D007362:Intensive Care Units; D009751:Nutritional Requirements; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D011188:Potassium / Q000378:metabolism / Q000627:therapeutic use
D007328:Insulin; D005947:Glucose; D011188:Potassium