Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, Netherlands.
JPEN J Parenter Enteral Nutr. 2012 Jan;36(1):60-8. doi: 10.1177/0148607111415109. Epub 2011 Dec 13.
Optimal nutrition for patients in the intensive care unit has been proposed to be the provision of energy as determined by indirect calorimetry and the provision of protein of at least 1.2 g/kg.
Prospective observational cohort study in a mixed medical-surgical intensive care unit in an academic hospital. In total, 886 consecutive mechanically ventilated patients were included. Nutrition was guided by indirect calorimetry and protein provision of at least 1.2 g/kg. Cumulative intakes were calculated for the period of mechanical ventilation. Cox regression was used to analyze the effect of protein + energy target achieved or energy target achieved versus neither target achieved on 28-day mortality, with adjustments for sex, age, body mass index, Acute Physiology and Chronic Health Evaluation II, diagnosis, and hyperglycemic index.
Patients' mean age was 63 ± 16 years; body mass index, 26 ± 6; and Acute Physiology and Chronic Health Evaluation II, 23 ± 8. For neither target, energy target, and protein + energy target, energy intake was 75% ± 15%, 96% ± 5%, and 99% ± 5% of target, and protein intake was 72% ± 20%, 89% ± 10%, and 112% ± 12% of target, respectively. Hazard ratios (95% confidence interval) for energy target and protein + energy target were 0.83 (0.67-1.01) and 0.47 (0.31-0.73) for 28-day mortality.
Optimal nutritional therapy in mechanically ventilated, critically ill patients, defined as protein and energy targets reached, is associated with a decrease in 28-day mortality by 50%, whereas only reaching energy targets is not associated with a reduction in mortality.
重症监护病房患者的最佳营养方案被提议为通过间接测热法确定能量供给，并提供至少 1.2 g/kg 的蛋白质。
这是一项在学术医院混合内科-外科重症监护病房进行的前瞻性观察性队列研究。共纳入 886 例连续接受机械通气的患者。营养供给由间接测热法和至少 1.2 g/kg 的蛋白质供给指导。计算机械通气期间的累积摄入量。使用 Cox 回归分析蛋白质+能量目标达成与能量目标达成与两者均未达成对 28 天死亡率的影响，调整因素包括性别、年龄、体重指数、急性生理学和慢性健康评估 II、诊断和高血糖指数。
患者的平均年龄为 63 ± 16 岁；体重指数为 26 ± 6；急性生理学和慢性健康评估 II 评分为 23 ± 8。对于两者均未达成、能量目标达成和蛋白质+能量目标达成，能量摄入分别为目标的 75% ± 15%、96% ± 5%和 99% ± 5%，蛋白质摄入分别为目标的 72% ± 20%、89% ± 10%和 112% ± 12%。能量目标和蛋白质+能量目标的危险比（95%置信区间）分别为 0.83（0.67-1.01）和 0.47（0.31-0.73），用于 28 天死亡率。
在接受机械通气的重症患者中，达到蛋白质和能量目标的最佳营养治疗与 28 天死亡率降低 50%相关，而仅达到能量目标与死亡率降低无关。
