Metabolism and Artificial Nutrition in the Critically Ill

1. Front Matter

   Pages I-XIV

   PDF

2. Basics and Methods

   1. Front Matter

      Pages 1-1

      PDF

   2. Substrate metabolism in critical illness

      • R. R. Wolfe

      Pages 3-10

   3. Measurement of the body composition

      • S. J. S. Ryde

      Pages 11-27

   4. Energy and ATP: Costs and benefits

      • J. P. Flatt

      Pages 29-45

   5. Indirect calorimetry in the critically ill: theoretical aspects and practical problems

      • L. S. Brandi, L. Santini, R. Bertolini

      Pages 47-57

3. Local and Systemic Effects on Metabolism

   1. Front Matter

      Pages 59-59

      PDF

   2. Hormonal response of the hypothalamo-pituitary-adrenal axis in injury

      • R. Chiolero, F. Pralong, R. Gaillard

      Pages 61-70

   3. Sympathetic nervous system and metabolism

      • G. L. Carlson, R. A. Little

      Pages 71-83

   4. Regional and systemic metabolic effects after surgical injury

      • G. Sganga, I. Giovannini, C. Chiarla, M. Castagneto

      Pages 85-92

   5. What about metabolism and the glutathione system?

      • J. Wernerman, J.-L. Luo, F. Hammarqvist

      Pages 93-100

   6. Carbohydrate and insulin activity in critically ill patients

      • R. R. Wolfe

      Pages 101-104

   7. Muscle catabolism, amino acid flux and protein turnover in injury

      • G. Biolo

      Pages 105-111

4. TPN vs ENT Nutrition Cost and Benefits

   1. Front Matter

      Pages 113-113

      PDF

   2. Total parenteral nutrition vs total enteral nutrition in critically ill patients: Costs and benefits

      • F. Iscra, A. Randino, G. Sermann

      Pages 115-122

5. New Strategies on Metabolism and Nutrition

   1. Front Matter

      Pages 123-123

      PDF

   2. Hormone and growth factors in intensive care patients: Anabolic strategy or utopia?

      • C. Pichard, P. Jolliet

      Pages 125-132

   3. Which metabolic strategies in the early phase of injury?

      • G. Iapichino, A. Pezzi, D. Radrizzani, S. Marzorati

      Pages 133-145

   4. Effects of artificial nutrition on the immune system cells

      • M. Braga, O. Gentilini, L. Gianotti, A. Vignali

      Pages 147-160

   5. Selective antioxidants and early artificial nutrition as prevention of multiple organ failure

      • D. W. Wilmore

      Pages 161-168

The critically ill patient in intensive care may present with serious metabolic alterations caused directly by the illness or secondarily by complications (e.g. infections, organ failure or sepsis) developing within a few hours of hospitaliza­ tion or in the following days. Among the situations which maintain and further trigger rapidly evolving altered metabolism are complex hormonal reactions, particularly those of the hypothalamus-hypophysis-adrenal axis, and abnormal stimulation of the autonomic nervous system. In fact, the sympathetic nervous system is known to cause significant metabolic alterations. For example, a surgery patient afflicted by septic complications may become hypercatabolic and experience significant nitrogen loss; the altered protein metabolism may in turn heavily influence carbohydrate and lipid metabolism as well. Thus, it is apparent that for optimal care of patients with altered metabolic functions, further knowledge is necessary regarding the physiopathology of metabolism and the physiopathological mechanisms, which alter the consump­ tion of principal energy substrates. Many experimental and clinical studies have investigated the metabolic aspects of individual organs or organ systems. However, for a correct evaluation of such metabolic events, in addition to studying the roles of metabolic enzymes, active metabolites, and the glutathione system, it is interesting to consider the use of indirect calorimetry as a valid and important investigative technique. The critically ill patient with major alterations in nutritional status may require artificial nutritive support administered through either parenteral or enteral routes.

• Enteral nutrition
• Insulin
• Parenteral nutrition
• Sepsis
• Trauma
• artificial nutrition
• body composition
• carbohydrate
• cells
• growth factor
• nutrition
• pathophysiology
• physiology
• prevention
• surgery
• metabolic disease

• Institute of General Clinical Medicine, Cattinara Hospital, Trieste, Italy

  G. Guarnieri

• Department of Anaesthesia, Intensive Care and Pain Therapy, Cattinara Hospital, Trieste, Italy

  F. Iscra

Policies and ethics