University of Tennessee-Memphis, Memphis, TN 38136, USA.
Nutr Clin Pract. 2011 Feb;26(1):48-54. doi: 10.1177/0884533610393254.
Despite considerable efforts to define energy requirements for critically ill patients, no single method has been found to be precise and unbiased for all patients. As a result, clinicians have used various methods that may overestimate energy requirements for some patients. Provision of target caloric intake without regard to the complications of overfeeding, such as hyperglycemia, hypercapnia, or gastric feeding intolerance, could result in overall detrimental clinical outcome. Inadequate nutrition support is also associated with adverse clinical outcomes that necessitate optimization of delivery and tolerance of the nutrition regimen. A pivotal paper by Krishnan and colleagues published in 2003 brought these issues to the forefront of clinical practice. Key papers that support or refute the practice of "permissive underfeeding" are reviewed. Further research is necessary to determine the minimum amount of nutrition required to achieve a therapeutic benefit as well as to ascertain at what amount of additional nutrition intake offers no further improvement in clinical outcome.
尽管人们做出了巨大努力来确定危重症患者的能量需求，但仍未找到一种适用于所有患者的精确且无偏倚的方法。因此，临床医生使用了各种可能会高估某些患者能量需求的方法。在不考虑过度喂养相关并发症（如高血糖、高碳酸血症或胃喂养不耐受）的情况下提供目标热量摄入，可能会导致整体临床结局恶化。营养支持不足也与不良临床结局相关，这需要优化营养方案的给予和耐受。2003 年，Krishnan 及其同事发表的一篇重要论文将这些问题提上了临床实践的首要位置。本文回顾了支持或反驳“允许性低喂养”做法的重要论文。还需要进一步研究来确定实现治疗益处所需的最低营养量，以及确定额外摄入多少营养不会进一步改善临床结局。
