Effects of pharmaconutrients on cellular dysfunction and the microcirculation in critical illness.
OBJECTIVE
A growing body of data has revealed that specific nutrient deficiencies contribute to microvascular and cellular dysfunction following critical illness. Further, targeted administration of these 'pharmaconutrients' may reverse or improve this dysfunction and improve clinical outcome.


RESULTS
Specific nutrient therapy with glutamine protects cellular metabolism and vascular function via induction of heat shock proteins, which are key proteins found to be deficient following acute illness. Arginine becomes rapidly deficient following trauma and surgery. This leads to significant immunosuppression, which when treated by arginine administration significantly reduces postoperative infection. Omega-3 fatty acids attenuate the inflammatory response and provide for resolution of ongoing inflammatory injury via production of resolvins/protectins. Antioxidants (vitamin C and selenium) and trace elements (zinc) become rapidly depleted in critical illness and replacement appears vital to ensure optimal cellular and microvascular function. Data on targeted metabolic (mitochondrial) therapies (i.e. co-enzyme Q10) show promise to improve myocardial function following cardiac surgery.


CONCLUSIONS
These specific nutrients have newly discovered vital mechanistic roles in the optimization of cellular and microcirculatory function in critical illness and injury. A growing body of literature is demonstrating that correction of key nutrient deficiencies via therapeutic administration of these pharmaconutrients can improve clinical outcome in critically ill patients.
Weitzel
Lindsay-Rae B
LR
Department of Anesthesiology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado 80045, USA. Lindsay.Weitzel@UCHSC.edu
Mayles
William J
WJ
Sandoval
Paul A
PA
Wischmeyer
Paul E
PE
D000818:Animals; D000975:Antioxidants / Q000627:therapeutic use; D001120:Arginine / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D002477:Cells / Q000187:drug effects* / Q000378:metabolism; D016638:Critical Illness / Q000628:therapy*; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005973:Glutamine / Q000172:deficiency / Q000627:therapeutic use; D006360:Heat-Shock Proteins / Q000096:biosynthesis; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D008833:Microcirculation / Q000187:drug effects*; D018977:Micronutrients / Q000627:therapeutic use*; D012643:Selenium / Q000172:deficiency / Q000378:metabolism; D015032:Zinc / Q000172:deficiency / Q000627:therapeutic use
D000975:Antioxidants; D015525:Fatty Acids, Omega-3; D006360:Heat-Shock Proteins; D018977:Micronutrients; D005973:Glutamine; D001120:Arginine; D012643:Selenium; D015032:Zinc; D001205:Ascorbic Acid