Physiopathologie de la dénutrition en réanimation

The prevalence of malnutrition is close to 50% at admission in hospital and particularly in intensive care unit (ICU). Most often, nutritional status worsens during the stay in ICU due to various stresses and insufficient nutrient intake. The aggression state induces an increase in energy expenditure and protein catabolism. Such a metabolic adaptation causes significant changes in body composition and more precisely a decrease in lean body mass. The decrease in muscle mass is associated with myofiber structural and functional alterations compromising patient rehabilitation. During the year following the stay in ICU, patients are characterized by the persistence or even worsening of the protein-energy malnutrition and a mortality rate of about 20%. These data underline the importance of understanding the pathophysiology of malnutrition in the ICU, discussed in this article, and its management.