Chronic Critical Illness and PICS Nutritional Strategies
The nutritional hallmark of chronic critical illness (CCI) after sepsis is persistent inflammation, immunosuppression, and catabolism syndrome (PICS), which results in global resistance to the anabolic effect of nutritional supplements. This ultimately leaves these patients in a downward phenotypic...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-05-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/11/2294 |
| _version_ | 1797532707059662848 |
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| author | Martin D. Rosenthal Erin L. Vanzant Frederick A. Moore |
| author_facet | Martin D. Rosenthal Erin L. Vanzant Frederick A. Moore |
| author_sort | Martin D. Rosenthal |
| collection | DOAJ |
| description | The nutritional hallmark of chronic critical illness (CCI) after sepsis is persistent inflammation, immunosuppression, and catabolism syndrome (PICS), which results in global resistance to the anabolic effect of nutritional supplements. This ultimately leaves these patients in a downward phenotypic spiral characterized by cachexia with profound weakness, decreased capacity for rehabilitation, and immunosuppression with the propensity for sepsis recidivism. The persistent catabolism is driven by a pathologic low-grade inflammation with the inability to return to homeostasis and by ongoing increased energy expenditure. Better critical care support systems and advances in technology have led to increased intensive care unit (ICU) survival, but CCI due to PICS with poor long-term outcomes has emerged as a frequent phenotype among ICU sepsis survivors. Unfortunately, therapies to mitigate or reverse PICS-CCI are limited, and recent evidence supports that these patients fail to respond to early ICU evidence-based nutrition protocols. A lack of randomized controlled trials has limited strong recommendations for nutrition adjuncts in these patients. However, based on experience in other conditions characterized by a similar phenotype, immunonutrients aimed at counteracting inflammation, immunosuppression, and catabolism may be important for improving outcomes in PICS-CCI patients. This manuscript intends to review several immunonutrients as adjunctive therapies in treating PICS-CCI. |
| first_indexed | 2024-03-10T11:04:06Z |
| format | Article |
| id | doaj.art-1acf007e14a949e9906d730fffce77ed |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T11:04:06Z |
| publishDate | 2021-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1acf007e14a949e9906d730fffce77ed2023-11-21T21:16:00ZengMDPI AGJournal of Clinical Medicine2077-03832021-05-011011229410.3390/jcm10112294Chronic Critical Illness and PICS Nutritional StrategiesMartin D. Rosenthal0Erin L. Vanzant1Frederick A. Moore2Division of Acute Care Surgery and the Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL 32610, USADivision of Acute Care Surgery and the Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL 32610, USADivision of Acute Care Surgery and the Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL 32610, USAThe nutritional hallmark of chronic critical illness (CCI) after sepsis is persistent inflammation, immunosuppression, and catabolism syndrome (PICS), which results in global resistance to the anabolic effect of nutritional supplements. This ultimately leaves these patients in a downward phenotypic spiral characterized by cachexia with profound weakness, decreased capacity for rehabilitation, and immunosuppression with the propensity for sepsis recidivism. The persistent catabolism is driven by a pathologic low-grade inflammation with the inability to return to homeostasis and by ongoing increased energy expenditure. Better critical care support systems and advances in technology have led to increased intensive care unit (ICU) survival, but CCI due to PICS with poor long-term outcomes has emerged as a frequent phenotype among ICU sepsis survivors. Unfortunately, therapies to mitigate or reverse PICS-CCI are limited, and recent evidence supports that these patients fail to respond to early ICU evidence-based nutrition protocols. A lack of randomized controlled trials has limited strong recommendations for nutrition adjuncts in these patients. However, based on experience in other conditions characterized by a similar phenotype, immunonutrients aimed at counteracting inflammation, immunosuppression, and catabolism may be important for improving outcomes in PICS-CCI patients. This manuscript intends to review several immunonutrients as adjunctive therapies in treating PICS-CCI.https://www.mdpi.com/2077-0383/10/11/2294persistent inflammation immunosuppression catabolism syndromechronic critical illnessmalnutritionPICSimmunonutritionhigh protein |
| spellingShingle | Martin D. Rosenthal Erin L. Vanzant Frederick A. Moore Chronic Critical Illness and PICS Nutritional Strategies Journal of Clinical Medicine persistent inflammation immunosuppression catabolism syndrome chronic critical illness malnutrition PICS immunonutrition high protein |
| title | Chronic Critical Illness and PICS Nutritional Strategies |
| title_full | Chronic Critical Illness and PICS Nutritional Strategies |
| title_fullStr | Chronic Critical Illness and PICS Nutritional Strategies |
| title_full_unstemmed | Chronic Critical Illness and PICS Nutritional Strategies |
| title_short | Chronic Critical Illness and PICS Nutritional Strategies |
| title_sort | chronic critical illness and pics nutritional strategies |
| topic | persistent inflammation immunosuppression catabolism syndrome chronic critical illness malnutrition PICS immunonutrition high protein |
| url | https://www.mdpi.com/2077-0383/10/11/2294 |
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