Introduction to the lipoprotein series

Excerpt

Since D.P. Cuthbertson [1] observed nearly 75 years ago that victims of severe injury or illness enter a state of protein catabolism, investigators in critical care medicine have observed that many critically ill or injured patients suffer severe metabolic abnormalities. In the acutely critically ill, alterations in the neuroendocrine axis [2], the response to human growth hormone [3], and circulating levels of insulin-like growth hormone I [4] are observed. Chronically ventilator-dependent individuals may suffer significant abnormalities in androgen production and bone resorption [5, 6]. The pace of our acquisition of knowledge in the area of the metabolism of critical illness has quickened in recent years, and major clinical trials suggest that establishing euglycemia [7, 8] or adequate glucocorticoid levels [9, 10] in the critically ill may yield important clinical benefits. Other clinical studies, however, have shown that attempts to establish normal nitrogen balance with growth hormone treatment may be detrimental [11]. Recently investigators have focused their attention on changes in lipoprotein metabolism in critical illness, currently the subject of two comprehensive reviews in this issue of Intensive Care Medicine [12, 13]. …