Abstract
This article discusses the importance of eliciting the mechanisms of action and the metabolism of microbiota in the critically ill patients, as well as the role of nutrition specialist in the management of these patients.In critically ill patients the impaired regulation of endogenous metabolic processes and protein-energy deficiency are aggravated by abnormal microbiota metabolic processes. There is growing awareness of the importance of studying microbial metabolism in the general metabolic process. Its implications for the improved efficacy of treatment in critical care and rehabilitation are obvious.Current international intensive care guidelines are being constantly revised in response to the new research data available on the mechanisms of critical illness. The course of the latter may significantly associate with the metabolic activity of human microbiota. Active management of metabolic processes is being sought through the subordination of bacterial metabolism to the interests of the host. Both antimicrobial and bioformulations (prebiotics, metabiotics) will be used in the long term in a targeted manner with the control of key microbial metabolites through available laboratory monitoring tools.Based on the literature data and the original research, the author formulates postulates of the microbiota metabolism in critical illness, introduces the concepts of «invisible organ dysfunction» and «signaling bacterial molecules», offers answers to the eternal «what is to be done?» question and suggests using a number of microbial aromatic amino acids metabolites as an integral indicator of a course of critical illness.
Highlights
The metabolomic approach to sepsis and the possibility to evaluate the evolution of the process using an integral index will make it possible to use the antimicrobial therapy regimens based on antibiotics with different mechanisms of action in the treatment of septic patients [14, 100,101,102]
We have described a novel approach to antimicrobial therapy as a targeted regulation of microbial signaling molecules
The severity of metabolic disorders associated with «invisible organ» dysfunction in intensive care patients can be evaluated objectively using blood profile of the aromatic signaling metabolites, which can be utilized as an integral indicator of metabolomic condition in sepsis
Summary
The metabolomic approach to sepsis and the possibility to evaluate the evolution of the process using an integral index (the level of aromatic metabolites) will make it possible to use the antimicrobial therapy regimens based on antibiotics with different mechanisms of action in the treatment of septic patients [14, 100,101,102]. The severity of metabolic disorders associated with «invisible organ» dysfunction (microbiota and mitochondria) in intensive care patients can be evaluated objectively using blood profile of the aromatic signaling metabolites, which can be utilized as an integral indicator of metabolomic condition in sepsis. The altered profile of aromatic metabolites in the blood representing multiple impaired functions of the «invisible organ» is an integral indicator
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