Critical care : the official journal of the Critical Care Forum
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Adipocyte morphological changes in critically ill patients have been reported, potentially providing beneficial effects. Marques and colleagues reported that these morphological adipocyte changes, as well as accumulation of M2 phenotype macrophages, occur irrespective of nutritional status in the critically ill. The present study provides insight into the alterations that occur, although further studies are needed to fully understand the role that adipose tissue plays in the critically injured.
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Different types of shock induce distinct metabolic changes. The myocardium at rest utilizes free fatty acids as its primary energy source, a mechanism that changes to aerobic glycolysis during sepsis and is in contrast to hemorrhagic shock. The immune system also uses this mechanism, changing its substrate utilization to activate innate and adaptive cells. Cardiomyocytes share a number of features similar to antigen-presenting cells and may use this mechanism to augment the immune response at the reversible expense of cardiac function.