Other aspects of metabolic monitoring in critically ill patients

Abstract

Cardiopulmonary monitoring remains the mainstay of intensive-care unit utilization of clinical chemistry resources. Its focus has been on the restoration and maintenance of oxygen transport. Metabolic monitoring, a relatively new area of application for clinical chemistry technology, focuses on cell metabolism and on cell-cell interaction as a mechanism of metabolic regulation. This latter application of monitoring is developing as a result of a better understanding of the pathogenesis of organ dysfunction and disease processes in intensive-care unit patients. Some of the clinical chemistry technologies used include analyses for amino acids and polyunsaturated fatty acids, measurement of cytokine concentration and activity, nutritional assessment and monitoring, more sensitive monitors of liver function, and assessment of altered immunity in critically ill patients. Use of these technologies, along with specific support measures, offers new avenues for decreasing infectious complications and reducing mortality and morbidity of patients in intensive-care units.

Immunonutrition in Patients Undergoing Major Upper Gastrointestinal Surgery: A Prospective Double-Blind Randomised Controlled Study

“…The role of visceral proteins have been widely publicised in the critical care setting; (14,15,16,17,18,19,20,21) in the search for a 'perfect' nutritional parameter, which is unaffected by the inflammatory response, or other disease processes. Prealbumin or transthyretin circulates on a one-to-one molar ratio with retinol binding protein.…”

“…RBP values in the immunonutrition group dropped from preoperative values of 36 mg/L (24-47) to 11 mg/L (11-15) on day 5. In the control group these values dropped from 42 mg/L (30-49) to 15.5 mg/L (13)(14)(15)(16)(17)(18). The exact p-value of 0.459 indicated no significant group differences at day 5.…”

Sequential Changes in Insulin‐Like Growth Factor 1, Plasma Proteins, and Total Body Protein in Severe Sepsis and Multiple Injury

“…The facility is located beside the surgical wards at Auckland Hospital, near the DCCM, and is uniquely able to measure the body composition of a critically ill patient while they are receiving intensive care therapies. The accuracy and precision of the system have been described in detail elsewhere and are of the order of 4% and 3.5%, respectively 1,5 Paired scans are performed to improve the precision. TBP before illness was estimated from sex, age, and measured height, using a regression equation developed from 27 healthy volunteers who underwent whole-body IVNAA scans:…”