Nutrition Unit, Geneva University Hospital, Geneva, Switzerland.
Curr Opin Clin Nutr Metab Care. 2010 Mar;13(2):177-83. doi: 10.1097/MCO.0b013e32833574b9.
In the setting of ICU, the characteristics of patients have changed during the last decade. Patients are older, frequently overweight or obese, present with more chronic diseases and undernutrition. These conditions are characterized by reduced muscle mass and vulnerable homeostasis. This review sustains the hypothesis that an early and optimal nutritional support, combining enteral and parenteral nutrition, could improve the clinical outcome of ICU patients.
The combination of stress and undernutrition observed in the ICUs is associated with negative energy balance, which leads to lean body mass loss. Catabolism of lean body mass has been repeatedly associated with a worsening of the clinical outcome, increased length of hospital stay, recovery and healthcare costs. Early enteral nutrition is the recommended feeding route in ICU patients, but it is often unable to fully cover the nutritional needs. Parenteral nutrition is recommended if enteral nutrition is not feasible.
It is hypothesized that supplemental parenteral nutrition, together with insufficient enteral nutrition, could optimize the nutritional therapy by preventing the onset of early energy deficiency, and thus, could allow to reduce the side-effects of undernutrition and promote better chances of recovery after the ICU stay.
在 ICU 环境中，患者的特征在过去十年中发生了变化。患者年龄更大，经常超重或肥胖，患有更多的慢性疾病和营养不良。这些情况的特点是肌肉量减少和脆弱的体内平衡。本综述支持这样一种假设，即早期和最佳的营养支持，结合肠内和肠外营养，可以改善 ICU 患者的临床结局。
在 ICU 中观察到的应激和营养不良的结合与负氮平衡有关，导致瘦体组织质量的损失。瘦体组织的分解代谢与临床结局的恶化、住院时间延长、恢复和医疗保健成本增加反复相关。早期肠内营养是 ICU 患者推荐的喂养途径，但往往无法完全满足营养需求。如果肠内营养不可行，则推荐使用肠外营养。
据推测，补充肠外营养与不足的肠内营养相结合，可以通过预防早期能量缺乏的发生来优化营养治疗，从而减少营养不良的副作用，并在 ICU 停留后促进更好的恢复机会。
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