Nutrition in Clinical Practice

 

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Nutrition in Clinical Practice, Vol. 21, No. 6, 587-604 (2006)
DOI: 10.1177/0115426506021006587
© 2006 The American Society for Parenteral and Enteral Nutrition

Invited Review

Nutrition Support and the Chronic Critical Illness Syndrome

Jason M. Hollander, MD and Jeffrey I. Mechanick, MD, FACP, FACE, FACN

Division of Endocrinology, Diabetes and Bone Disease, Mount Sinai School of Medicine, New York, New York

Correspondence: Jeffrey I. Mechanick, MD, 1192 Park Avenue, New York, NY 10128. Electronic mail may be sent to jmechanick{at}aol.com.

Critical illness can be viewed as consisting of 4 distinct stages: (1) acute critical illness (ACI), (2) prolonged acute critical illness, (3) chronic critical illness, and (4) recovery. ACI represents the evolutionarily programmed response to a stressor. In ACI, substrate is shunted away from anabolism and toward vital organ support and inflammatory proteins. Nutrition support in this stage is unproven and may ultimately prove detrimental. As critical illness progresses, there is no evolutionary precedent, and man owes his life to modern critical care medicine. It is at this point that nutrition and metabolic support become integral to the care of the patient. This paper (1) delineates and develops the 4 stages of critical illness using current evidence, clinical experience, and new hypotheses; (2) defines the chronic critical illness syndrome (CCIS); and (3) details an approach to the metabolic and nutrition support of the chronically critically ill patient using the metabolic model of critical illness as a guide. It is our hope that this clinical model can generate testable hypotheses that can improve the outcome of this unique population of patients.


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