Cachexia
OVERVIEW
- Cachexia refers to weight loss and skeletal muscle wasting due to illness where the body does not reduce catabolism (unlike the adaptive reduction in protein metabolism that occurs in starvation)
- Mechanisms not clearly understood
PREDISPOSING FACTORS
- Pre-existing malnutrition / malabsorption
- Cytokine-induced up-regulation of muscle protein degradation
- Neuro-endocrine – stimulation of hypothalamic-pituitary-adrenal axis
- Reduced circulating anabolic hormones
- Immobility and prolonged length of stay
- Corticosteroid therapy
- Malignancy
CONSEQUENCES
- Increased risk of death
- Prolonged time on ventilator
- Increased ICU and hospital length of stay
- Increased risk of nosocomial infections
- Poor wound healing
- Weakness and slow respiratory weaning
- Malnutrition and nutritional deficiency syndromes
References and Links
- Gordon JN, Green SR, Goggin PM. Cancer cachexia. QJM. 2005 Nov;98(11):779-88. PMID: 16214835.
- Morley JE, Thomas DR, Wilson MM. Cachexia: pathophysiology and clinical relevance. Am J Clin Nutr. 2006 Apr;83(4):735-43. PMID: 16600922.
- von Haehling S, Doehner W, Anker SD. Nutrition, metabolism, and the complex pathophysiology of cachexia in chronic heart failure. Cardiovasc Res. 2007 Jan 15;73(2):298-309.PMID: 17034772.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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