Critical illness-based chronic disease: a new framework for intensive metabolic support.

Abstract

Purpose of review: This review addresses the novel concept of critical illness as a potential chronic disease. The high clinical and economic burdens of chronic critical illness and post-ICU syndromes are mainly due to refractoriness to therapy and consequently lead to significant complications. Interventions need to be preventive in nature and therefore a robust disease model is warranted.

Recent findings: There are three paradigms that are leveraged to create a new critical illness-based chronic disease (CIBCD) model: metabolic model of critical illness, intensive metabolic support (IMS; insulinization and nutrition support), and driver-based chronic disease modeling. The CIBCD model consists of four stages: risk, predisease, (chronic) disease, and complications. The principal goal of the CIBCD model is to expose early opportunities to prevent disease progression, particularly further morbidity, complications, and mortality. IMS is used to target seminal pathophysiological events such as immune-neuroendocrine axis (INA) activation and failure to downregulate INA activation because of preexisting chronic diseases and recurrent pathological insults.

Summary: The CIBCD model complements our understanding of critical illness and provides needed structure to preventive actions that can improve clinical outcomes. Many research, knowledge, and practice gaps exist, which will need to be addressed to optimize and validate this model.