Impact of new technologies on metabolic care in the intensive care unit

Corey Scurlock, Jayashree Raikhelkar, Jeffrey I. Mechanick

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations


Purpose of review Technological innovations in the ICU have lead to extraordinary advances in modern critical care. Renal replacement therapy (RRT) innovations and ventricular assist devices (VAD) are now becoming common interventions in the ICU environment. The purpose of this article is to describe the impact of RRT and VAD on critical care medicine with particular reference to metabolic care. Recent findings Continuous venovenous hemofiltration and slow low efficient daily dialysis are effective modalities of RRT in hemodynamically unstable patients. These continuous forms of RRT can result in accentuated protein and nutrient losses but also provide an opportunity for intradialytic parenteral nutrition support. VAD patients typically have cardiac cachexia and develop chronic critical illness syndrome. Intensive metabolic support, incorporating trophic, concentrated, semielemental enteral nutrition, supplemental parenteral nutrition, and intensive insulin therapy is a rational strategy to implement in VAD patients. Unfortunately, there is insufficient evidence at this time to support the routine use of these nutritional interventions with RRT and VAD. Summary Patients requiring RRT or VAD are at high nutritional risk, which negatively affects ICU outcome. Prompt nutritional risk assessment and early optimization of metabolic care is crucial in this patient population.

Original languageEnglish
Pages (from-to)196-200
Number of pages5
JournalCurrent Opinion in Clinical Nutrition and Metabolic Care
Issue number2
StatePublished - Mar 2009


  • Intensive metabolic support
  • Intradialytic parenteral nutrition
  • Nutritional support
  • Renal replacement therapy
  • Ventricular assist device


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