Other aspects of metabolic monitoring in critically ill patients

Cardiopulmonary monitoring remains the mainstay of intensive-care unit utilization of clinical chemistry resources. Its focus has been on the restoration and maintenance of oxygen transport. Metabolic monitoring, a relatively new area of application for clinical chemistry technology, focuses on cell metabolism and on cell-cell interaction as a mechanism of metabolic regulation. This latter application of monitoring is developing as a result of a better understanding of the pathogenesis of organ dysfunction and disease processes in intensive-care unit patients. Some of the clinical chemistry technologies used include analyses for amino acids and polyunsaturated fatty acids, measurement of cytokine concentration and activity, nutritional assessment and monitoring, more sensitive monitors of liver function, and assessment of altered immunity in critically ill patients. Use of these technologies, along with specific support measures, offers new avenues for decreasing infectious complications and reducing mortality and morbidity of patients in intensive-care units.