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As part of the normal stress response, relative insulin resistance develops, and glucose is not as readily used by tissues leading to increased break- down of protein and fat stores. fte so-called protein-sparing effect of intravenous glucose solutions in critically ill patients is incon- sequential, and this should never be thought of as addressing nutritional needs for the sickest patients.
A study from the United Kingdom looked at acute skeletal muscle wasting in critically ill patients who were in the ICU more than 7 days and on mechanical ventilation for at least 2 days and found that there were significant declines in the cross-sectional area of the quadriceps muscle, measured by ultrasound, and increased muscle breakdown. ftese negative effects were seen day 1 to day 7 of study enrollment and were greater in patients with multior- gan failure compared with patients with single-system failure, which suggests that the catabolic effects of critical illness are pro- portional to the "dose" of the illness.
Furthermore, the degree of muscle loss correlated with increases in C-reactive protein levels and decreases in oxygenation, supporting the concept that muscle wasting is a product of critical illness and organ failure.24 Although muscle loss and functional deficits are known to occur in healthy, well-fed individuals when placed on bed rest, these declines occur surprisingly quickly in critically ill patients, despite adequate delivery of calories and protein.
Alternatively, psoas muscle cross-sectional area can be used as a marker of cachexia and mal- nutrition and may have some prognostic value based on more recent data. fte shortcomings of using CT to assess nutritional status are cost, ionizing radiation, and need for transport; bedside tools such as ultrasound are gaining popularity and may become the standard way we monitor how effectively we are delivering nutrition to critically ill patients.
Critically ill patients have multiple factors adversely affecting their ability to eat or take in substrate to meet their nutritional needs, but there is often hesitancy among providers to address this problem.
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