Overview of modern management of patients with critical injury and severe sepsis

Over the last 10 years there have been substantial changes in the issues co nfronting intensivists and surgeons caring for critically ill patients. A s ubstantial increase in the number of elderly patients with surgical illness and complex co-morbidity has accompanied the increase in the proportion of elderly in populations in the developed world. This phenomenon has been se en particularly with sepsis, Incidence rates for blunt trauma have declined overall, but the problems of the elderly trauma patient have become more e vident. Major elective surgery remains a common indication for short-term i ntensive care in many countries, but the need for cost-containment has led to increased use of high-dependency care for many such patients. Expectatio ns of both society and clinicians have increased, and this has been reflect ed in the increased demand for complex procedures (e.g., liver transplantat ion, cerebral artery aneurysm clipping, aortic aneurysm repair) in patients previously considered at too high risk. Along with these expectations have come pressures on clinicians to reduce costs at the same time as improving clinical outcomes. Despite many advances in the care of critically ill pat ients with injury or sepsis, mortality, morbidity, and cost remain high; an d nutritional support is frequently required. The duration and extent of th e metabolic changes seen in response to critical surgical illness and inten sive care treatments have became better characterized. Although some of the changes in body water and fat are modifiable, loss of large amounts of (fu nctional) protein has been resistant to various strategies so far studied.