Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
Nutrition. 2011 May;27(5):509-12. doi: 10.1016/j.nut.2010.10.010. Epub 2011 Feb 4.
The provision of early nutrition therapy to critically ill patients is established as the standard of care in most intensive care units around the world. Despite the known benefits, tolerance of enteral nutrition in the critically ill varies and delivery is often interrupted. Observational research has demonstrated that clinicians deliver little more than half of the enteral nutrition they plan to provide. The main clinical tool for assessing gastric tolerance is gastric residual volume; however, its usefulness in this setting is debated. There are several strategies employed to improve the tolerance and hence adequacy of enteral nutrition delivery in the critically ill. One of the most widely used strategies is that of prokinetic drug administration, most commonly metoclopramide and erythromycin. Although there are new agents being investigated, none are ready for routine application in the critically ill and the benefits are still being established. This review investigates current practice and considers the literature on assessment of enteral tolerance and optimization of enteral nutrition in the critically ill.
早期营养治疗在危重病患者中的应用已被确立为全球大多数重症监护病房的护理标准。尽管有明确的益处，但危重病患者对肠内营养的耐受程度不同，且喂养往往会中断。观察性研究表明，临床医生提供的肠内营养量仅略多于其计划提供的量。评估胃耐受的主要临床工具是胃残留量;然而，其在这种情况下的有用性仍存在争议。有几种策略可用于提高危重病患者肠内营养的耐受性和充足性。最常用的策略之一是使用促动力药物，最常用的是甲氧氯普胺和红霉素。虽然正在研究新的药物，但没有一种药物可用于危重病患者的常规应用，其益处仍在建立中。这篇综述调查了当前的实践，并考虑了有关评估肠内耐受性和优化危重病患者肠内营养的文献。
