Persistent inflammation, immunosuppression, and catabolic syndrome: A new look at a growing problem

Nutrition support among critically ill patients in the intensive care unit remains a cornerstone to standard-of-care strategies. Clinicians rely on a robust body of literature, societal guidelines and recommendations, evidence-based protocols, and more to aid in the appropriate delivery of nutrients to this patient population. Among critically ill patients, there is a growing population of patients with smoldering multiorgan dysfunction (MOD) known as persistent inflammation, immunosuppression, and catabolic syndrome (PICS-1). The growth of this patient population is likely related not only to increasing awareness of chronic critically ill patients but also has evolved as intensive care management has improved following the development of bundles, protocols, evidence-based practice, and multidisciplinary care teams. PICS-1 is being recognized more frequently as these patients have survived and can be salvaged from MOD. Unfortunately, there is no evidence regarding nutrition support for these patients (other than inferences from other bodies of literature). This review will serve to describe the origins, a brief epidemiologic discussion, and potential nutrition supplements that may impact the clinical outcomes of PICS-1.