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The nutritional and metabolic support of heart failure in the intensive care unit

Joseph S Meltzer1, Vivek K Moitra

  • 1Division of Critical Care Medicine, Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA. jm2650@columbia.edu

Current Opinion in Clinical Nutrition and Metabolic Care
|February 28, 2008
PubMed

Insights

Nutritional and metabolic support, including supplements and intensive insulin therapy, can improve outcomes for critically ill heart failure patients in the ICU. Shifting the metabolic state to anabolic is key.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Nutritional Science

Background:

  • Heart failure and cardiovascular disease are leading causes of ICU admissions.
  • Nutritional deficiencies are linked to the progression of chronic heart failure.
  • Optimizing nutritional and metabolic support may enhance outcomes in critically ill heart failure patients.

Purpose of the Study:

  • To review the role of nutritional and metabolic support in the intensive care unit (ICU) for heart failure patients.
  • To analyze current evidence on interventions for critically ill heart failure patients.

Main Methods:

  • Literature review of nutritional and metabolic support strategies in acute heart failure care.
  • Analysis of studies on cardiac cachexia, nutritional supplements, intensive insulin therapy, and statin use.

Main Results:

  • Cardiac cachexia involves inflammation and anabolic-catabolic imbalance.
  • Supplements (selenium, vitamins, antioxidants) may support the failing myocardium.
  • Intensive insulin therapy shows utility in critically ill patients; statins have an emerging role.

Conclusions:

  • Key nutritional support strategies include shifting metabolism to anabolic, reducing oxidative stress, and managing inflammation.
  • Tight glycemic control via intensive insulin therapy is increasingly important in critical care.
  • Glucose-insulin-potassium therapy is not recommended for heart failure or acute myocardial infarction.
Abstract

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