title: Impact of new technologies on metabolic care in the intensive care unit.
abstract: OBJECTIVE
  Technological innovations in the ICU have lead to extraordinary advances in modern critical care. Renal replacement therapy (RRT) innovations and ventricular assist devices (VAD) are now becoming common interventions in the ICU environment. The purpose of this article is to describe the impact of RRT and VAD on critical care medicine with particular reference to metabolic care.
  
  
  RESULTS
  Continuous venovenous hemofiltration and slow low efficient daily dialysis are effective modalities of RRT in hemodynamically unstable patients. These continuous forms of RRT can result in accentuated protein and nutrient losses but also provide an opportunity for intradialytic parenteral nutrition support. VAD patients typically have cardiac cachexia and develop chronic critical illness syndrome. Intensive metabolic support, incorporating trophic, concentrated, semielemental enteral nutrition, supplemental parenteral nutrition, and intensive insulin therapy is a rational strategy to implement in VAD patients. Unfortunately, there is insufficient evidence at this time to support the routine use of these nutritional interventions with RRT and VAD.
  
  
  CONCLUSIONS
  Patients requiring RRT or VAD are at high nutritional risk, which negatively affects ICU outcome. Prompt nutritional risk assessment and early optimization of metabolic care is crucial in this patient population.
authors.affiliation: Cardiothoracic Surgical Intensive Care Unit, Department of Anesthesiology and Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 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: D058186:Acute Kidney Injury / Q000503:physiopathology; D002100:Cachexia / Q000209:etiology / Q000517:prevention & control; D003422:Critical Care; D006333:Heart Failure; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D018529:Nutritional Support / Q000379:methods*; D010288:Parenteral Nutrition; D017582:Renal Replacement Therapy / Q000009:adverse effects*; D018570:Risk Assessment; D013672:Technology