Department of Surgery, Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, Florida, USA.
Department of Pharmacy, UF Health, University of Florida College of Pharmacy, Gainesville, Florida, USA.
Nutr Clin Pract. 2018 Feb;33(1):39-45. doi: 10.1002/ncp.10024. Epub 2018 Jan 11.
Over the last decade, chronic critical illness (CCI) has emerged as an epidemic in intensive care unit (ICU) survivors worldwide. Advances in ICU technology and implementation of evidence-based care bundles have significantly decreased early deaths and have allowed patients to survive previously lethal multiple organ failure (MOF). Many MOF survivors, however, experience a persistent dysregulated immune response that is causing an increasingly predominant clinical phenotype called the persistent inflammation, immunosuppression, and catabolism syndrome (PICS). The elderly are especially vulnerable; thus, as the population ages the prevalence of this CCI/PICS clinical trajectory will undoubtedly grow. Unfortunately, there are no proven therapies to prevent PICS, and multimodality interventions will be required. The purpose of this review is to: (1) discuss CCI as it relates to PICS, (2) identify the burden on healthcare and poor outcomes of these patients, and (3) describe possible nutrition interventions for the CCI/PICS phenotype.
在过去的十年中，慢性危重病（CCI）已成为全球重症监护病房（ICU）幸存者中的一种流行疾病。ICU 技术的进步和基于证据的护理包的实施显著降低了早期死亡率，并使患者能够存活以前致命的多器官衰竭（MOF）。然而，许多 MOF 幸存者经历持续失调的免疫反应，导致一种越来越占主导地位的临床表型，称为持续炎症、免疫抑制和分解代谢综合征（PICS）。老年人尤其脆弱；因此，随着人口老龄化，这种 CCI/PICS 临床轨迹的患病率无疑会增加。不幸的是，目前尚无预防 PICS 的有效疗法，需要采取多模式干预措施。本综述的目的是：（1）讨论与 PICS 相关的 CCI，（2）确定这些患者的医疗保健负担和不良结局，以及（3）描述 CCI/PICS 表型的可能营养干预措施。
