title: Metabolic response to the stress of critical illness.
abstract: The metabolic response to stress is part of the adaptive response to survive critical illness. Several mechanisms are well preserved during evolution, including the stimulation of the sympathetic nervous system, the release of pituitary hormones, a peripheral resistance to the effects of these and other anabolic factors, triggered to increase the provision of energy substrates to the vital tissues. The pathways of energy production are altered and alternative substrates are used as a result of the loss of control of energy substrate utilization by their availability. The clinical consequences of the metabolic response to stress include sequential changes in energy expenditure, stress hyperglycaemia, changes in body composition, and psychological and behavioural problems. The loss of muscle proteins and function is a major long-term consequence of stress metabolism. Specific therapeutic interventions, including hormone supplementation, enhanced protein intake, and early mobilization, are investigated. This review aims to summarize the pathophysiological mechanisms, the clinical consequences, and therapeutic implications of the metabolic response to stress.
authors: Department of Intensive Care, Erasme University Hospital, Free University of Brussels, 808 route de Lennik, 1070 Brussels, Belgium jean-charles.preiser@erasme.ulb.ac.be.
authors: J-C
authors: JC
authors: Preiser
authors: Department of Anesthesiology and Intensive Care, Hôpital Saint-Roch, University of Nice, France.
authors: C
authors: C
authors: Ichai
authors: Department of Anesthesiology and Intensive Care, Hôpital Saint-Roch, University of Nice, France.
authors: J-C
authors: JC
authors: Orban
authors: Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: A B J
authors: AB
authors: Groeneveld
mesh_terms: D001823:Body Composition / Q000502:physiology; D016638:Critical Illness / Q000628:therapy*; D004044:Dietary Proteins / Q000008:administration & dosage; D004734:Energy Metabolism / Q000502:physiology; D020249:Hormone Replacement Therapy / Q000379:methods; D006801:Humans; D009490:Neurosecretory Systems / Q000503:physiopathology; D013312:Stress, Physiological / Q000502:physiology*
chemical_list: D004044:Dietary Proteins
keywords: body composition; critically ill; energy expenditure; energy substrate; hormone supplementation; macronutrient; neuroendocrine response