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Bone physiology and therapeutics in chronic critical illness
Michael A Via1, Emily Jane Gallagher, Jeffrey I Mechanick
1Division of Endocrinology and Metabolism, Beth Israel Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Annals of the New York Academy of Sciences
|November 11, 2010
Summary
Chronic critical illness, a prolonged critical condition requiring tracheotomy, leads to significant metabolic bone disease. This condition is characterized by increased bone breakdown and decreased bone formation, impacting patient recovery.
Area of Science:
- Critical care medicine
- Endocrinology
- Metabolic bone disease
Background:
- Modern medicine enables prolonged survival after acute illness.
- Chronic critical illness (CCI) is a distinct phase of prolonged critical illness.
- CCI is often associated with interventions like tracheotomy.
Purpose of the Study:
- To define chronic critical illness.
- To review the mechanisms of metabolic bone disease in CCI.
- To suggest potential therapeutic strategies for CCI.
Main Methods:
- Review of existing literature on critical illness.
- Analysis of patient data including inflammatory cytokines and hormonal function.
- Measurement of bone turnover markers.
Main Results:
- Patients with CCI exhibit persistent inflammatory cytokine elevation.
- Hypothalamic-pituitary function is diminished in CCI.
- Bone turnover markers show uncoupled osteoclastic resorption and osteoblastic formation, indicating metabolic bone disease.
Conclusions:
- Chronic critical illness is characterized by a specific metabolic bone disease.
- The bone disease in CCI results from a complex interplay of inflammation, hormonal dysfunction, and nutritional deficits.
- Targeting these mechanisms may offer therapeutic benefits for patients with CCI.
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