Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
JPEN J Parenter Enteral Nutr. 2013 May-Jun;37(3):300-9. doi: 10.1177/0148607113478192. Epub 2013 Mar 4.
Critical illness dramatically increases muscle proteolysis and more than doubles the dietary protein requirement. Yet surprisingly, most critically ill patients receive less than half the recommended amount of protein during their stay in a modern intensive care unit. What could explain the wide gap between the recommendations in clinical care guidelines and actual clinical practice? We suggest that an important aspect of the problem is the failure of guidelines to explain the pathophysiology of protein-energy malnutrition and the ways critical illness modifies protein metabolism. The difficulty created by the lack of a framework for reasoning about appropriate protein provision in critical illness is compounded by the many ambiguous and often contradictory ways the word malnutrition is used in the critical care literature. Failing to elucidate these matters, the recommendations for protein provision in the guidelines are incoherent, unconvincing, and easy to ignore.
危重病显著增加肌肉蛋白分解，使膳食蛋白质需求量增加一倍以上。然而令人惊讶的是，大多数危重病患者在入住现代化重症监护病房期间，接受的蛋白质不到推荐量的一半。那么，是什么导致了临床护理指南中的推荐与实际临床实践之间的巨大差距呢？我们认为，问题的一个重要方面是指南未能解释蛋白质-能量营养不良的病理生理学以及危重病改变蛋白质代谢的方式。由于缺乏一个关于危重病中适当蛋白质供应的推理框架，再加上“营养不良”一词在重症监护文献中经常被歧义地、甚至常常是矛盾地使用，这使得问题更加复杂。由于未能阐明这些问题，指南中关于蛋白质供应的建议是不一致的、没有说服力的，很容易被忽视。
