title: Intensive metabolic support: evolution and revolution.
abstract: OBJECTIVE
  To describe a new aspect of critical care termed intensive metabolic support.
  
  
  METHODS
  We performed a MEDLINE search of the English-language literature published between 1995 and 2008 for studies regarding the metabolic stages of critical illness, intensive insulin treatment, and intensive metabolic support in the intensive care unit, and we summarize the clinical data.
  
  
  RESULTS
  Intensive metabolic support is a 3-component model involving metabolic control and intensive insulin therapy, early nutrition support, and nutritional pharmacology aimed at preventing allostatic overload and the development of chronic critical illness. To improve clinical outcome and prevent mortality, intensive metabolic support should start on arrival to the intensive care unit and should end only when patients are in the recovery phase of their illness.
  
  
  CONCLUSIONS
  Intensive metabolic support should be an essential part of the daily treatment strategy in critical care medicine. This will involve a newfound and extensive collaboration between the endocrinologist and the intensivist. We call for well-designed future studies involving implementation of this protocol to decrease the burden of chronic critical illness.
authors.affiliation: Cardiothoracic Surgical Intensive Care Unit, Mount Sinai School of Medicine, New York, NY 10029, USA. corey.scurlock@mountsinai.org
authors.forename: Corey
authors.initials: C
authors.lastname: Scurlock
authors.forename: Jayashree
authors.initials: J
authors.lastname: Raikhelkar
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mechanick
mesh_terms: D001786:Blood Glucose; D003422:Critical Care / Q000379:methods*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D018529:Nutritional Support / Q000379:methods
chemical_list: D001786:Blood Glucose; D007328:Insulin