Kan Mee-Nin, Chang Han-Hsin, Sheu Woei-Fen, Cheng Chien-Hsiang, Lee Bor-Jen, Huang Yi-Chia
Intensive Care Unit, Taichung Veterans General Hospital, Taiwan, ROC.
Crit Care. 2003 Oct;7(5):R108-15. doi: 10.1186/cc2366. Epub 2003 Aug 28.
There is very little information on what is considered an adequate energy intake for mechanically ventilated, critically ill patients. The purpose of the present study was to determine this energy requirement by making use of patients' nutritional status.
The study was conducted in a multidisciplinary intensive care unit of Taichung Veterans General Hospital, Taiwan. Patients were hemodynamically stable and not comatose, and were requiring at least 7 days of mechanical ventilation. Fifty-four patients successfully completed this study. The resting energy expenditure was measured using indirect calorimetry. The total energy requirement was considered 120% of the measured energy expenditure. The daily nutrient intake was recorded. Nutritional status was assessed using single and multiple parameters, nitrogen balance, and medical records, and was performed within 24 hours of admission and after 7 days in the intensive care unit.
Fifteen patients were being underfed (<90% of total energy requirement), 20 patients were in the appropriate feeding (AF) group (within +/- 10% of total energy requirement), and 19 patients received overfeeding (>110% of total energy requirement). Patients in the underfeeding group received only 68.3% of their energy requirement, while the overfeeding group patients received up to 136.5% of their required calories. Only patients in the AF group had a positive nitrogen balance (0.04 +/- 5.1) on day 7. AF group patients had a significantly higher Nutritional Risk Index value at day 7 than at day 1.
AF patients had more improvement in nutritional status than patients in the other feeding groups. To provide at least 120% of the resting energy expenditure seemed adequate to meet the caloric energy needs of hemodynamically stable, mechanically ventilated, critically ill patients.
关于机械通气的危重症患者的适当能量摄入量，目前几乎没有相关信息。本研究的目的是通过利用患者的营养状况来确定这种能量需求。
本研究在台湾台中荣民总医院的多学科重症监护病房进行。患者血流动力学稳定且未昏迷，需要至少7天的机械通气。54名患者成功完成了本研究。使用间接测热法测量静息能量消耗。总能量需求被认为是测量的能量消耗的120%。记录每日营养摄入量。使用单一和多个参数、氮平衡以及病历评估营养状况，在入院后24小时内和重症监护病房住院7天后进行。
15名患者摄入不足（<总能量需求的90%），20名患者属于适当喂养（AF）组（在总能量需求的±10%范围内），19名患者摄入过量（>总能量需求的110%）。摄入不足组的患者仅获得其能量需求的68.3%，而摄入过量组的患者获得高达其所需卡路里的136.5%。只有AF组的患者在第7天有正氮平衡（0.04±5.1）。AF组患者在第7天的营养风险指数值显著高于第1天。
与其他喂养组的患者相比，AF组患者的营养状况改善更大。提供至少120%的静息能量消耗似乎足以满足血流动力学稳定、机械通气的危重症患者的热量需求。
