HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

METABOLIC SUPPORT STRATEGIES

Bilal Atilla Bezen

Afyonkarahisar Health Science University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Afyonkarahisar, Türkiye

Bezen BA. Metabolic Support Strategies. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.279-288.

ABSTRACT

Metabolic support strategies denote pharmalogical and nutritional treatments aimed at fulfilling the metabolic requirements of critically ill patients in the intensive care unit (ICU). These strategies seek to preserve energy balance, enhance organ functionality, reduce muscle loss, and optimize patient outcomes by addressing the metabolic alterations generated by stress in critical illness. Physiological stress resulting from critical illness induces significant metabolic disruptions marked by hypercatabolism, insulin resistance, and increased energy expenditure. The main purpose of these changes is to ensure survival; even impaired wound healing and weakened immune systems are taken into account for this purpose. To reduce or eliminate these and similar serious losses, metabolic support must be optimized, which is why metabolic support is an indispensable component of intensive care. Metabolic support given at the appropriate time and amount has been shown to reduce morbidity, shorten the length of stay in intensive care, and improve survival in some patient groups. Nevertheless, excessive or improper feeding tactics may result in severe problems, including hyperglycemia, refeeding syndrome, or fatty liver disease. Indirect calorimetry and prediction equations may be utilized for patients at the commencement of metabolic support. The distribution of macronutrients for nutritional support is essential, and the patient’s clinical condition may affect this allocation. Micronutrients are equally essential as macronutrients in metabolic support strategies, and in certain clinical scenarios, specific micronutrients must to be incorporated into the treatment. Metabolic support differs from nutritional support in that it encompasses pharmacological interventions, such as insulin infusion for hyperglycemia. This chapter aims to describe metabolic support strategies for critically ill patients, emphasizing evidence-based therapies and practical considerations.

Keywords: Critical care; Intensive care units; Critical illness; Malnutrition; Nutrition assessment; Nutritional support

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