Metabolic and nutrition support in the chronic critical illness syndrome.
Technological innovations in the ICU have led to artificially prolonged life, with an associated cost. Chronic critical illness (CCI) occurs in patients with prolonged mechanical ventilation and allostatic overload, and is associated with a discrete and consistent metabolic syndrome.  Metabolic interventions are extrapolated from clinical critical care research, scientific theory, and years of CCI patient care experience. Intensive metabolic support (IMS) is a multi-targeted approach consisting of tight glycemic control with intensive insulin therapy, early and adequate  nutrition therapy, nutritional pharmacology, management of metabolic bone disease, and meticulous attention to other endocrine/metabolic derangements. Ideally, IMS should be under the supervision of a metabolic support consultative team. Further research specifically focused on the CCI population  is needed to validate this current approach.
Division of Endocrinology, Diabetes, and Bone Diseases, Mount Sinai School of Medicine, New York, New York 10128, USA.
Rifka C
RC
Schulman
Jeffrey I
JI
Mechanick
D001851:Bone Diseases, Metabolic / Q000628:therapy; D002136:Calcium, Dietary / Q000008:administration & dosage; D002153:Calorimetry, Indirect; D002908:Chronic Disease; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D004734:Energy Metabolism; D004750:Enteral Nutrition; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D015596:Nutrition Assessment; D018529:Nutritional Support / Q000379:methods; D013577:Syndrome; D014807:Vitamin D / Q000008:administration & dosage; D014945:Wound Healing / Q000502:physiology
D002136:Calcium, Dietary; D014807:Vitamin D