Bistrian Bruce R, McCowen Karen C
Beth Israel Deaconess Medical Center and Harvard Medical School, Cambridge, MA, USA.
Crit Care Med. 2006 May;34(5):1525-31. doi: 10.1097/01.CCM.0000216704.54446.FD.
To discuss certain important features of nutrition and metabolism in the intensive care unit.
Prospective clinical trials examining issues related to glucose control, immunonutrition, and comparison of enteral and parenteral nutrition.
It remains unclear which glycemic threshold should be used in many patients for insulin initiation, but surgical patients receiving adequate nutrition should probably be treated to true normoglycemia. Immunonutrition may be beneficial in some populations, but the evidence does not justify its use in the intensive care unit. Contrary to popular belief, appropriately administered parenteral nutrition may provide similar or more benefit than enteral and clearly needs more widespread acceptance in cases where initiation of enteral nutrition is slow to start or is contraindicated.
探讨重症监护病房营养与代谢的某些重要特征。
关于血糖控制、免疫营养以及肠内营养与肠外营养比较等相关问题的前瞻性临床试验。
对于许多患者，启动胰岛素治疗时应采用何种血糖阈值仍不明确，但接受充足营养的外科患者可能应治疗至真正的血糖正常。免疫营养在某些人群中可能有益，但证据并不支持在重症监护病房使用。与普遍看法相反，合理给予的肠外营养可能比肠内营养提供相似或更多益处，并且在肠内营养启动缓慢或禁忌的情况下显然需要更广泛的接受。
