McClave Stephen A, Martindale Robert G, Rice Todd W, Heyland Daren K
1Department of Medicine, University of Louisville School of Medicine, Louisville, KY. 2Department of Surgery, Oregon Health Sciences University, Portland, OR. 3Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, TN. 4Department of Medicine, Queens University, Kingston, ON, Canada.
Crit Care Med. 2014 Dec;42(12):2600-10. doi: 10.1097/CCM.0000000000000654.
Critically ill patients are usually unable to maintain adequate volitional intake to meet their metabolic demands. As such, provision of nutrition is part of the medical care of these patients. This review provides detail and interpretation of current data on specialized nutrition therapy in critically ill patients, with focus on recently published studies.
The authors used literature searches, personal contact with critical care nutrition experts, and knowledge of unpublished data for this review.
Published and unpublished nutrition studies, consisting of observational and randomized controlled trials, are reviewed.
The authors used consensus to summarize the evidence behind specialized nutrition.
In addition, the authors provide recommendations for nutritional care of the critically ill patient.
Current evidence suggests that enteral nutrition, started as soon as possible after acute resuscitative efforts, may serve therapeutic roles beyond providing calories and protein. Although many new studies have further advanced our knowledge in this area, the appropriate level of standardization has not yet been achieved for nutrition therapy, as it has in other areas of critical care. Protocolized nutrition therapy should be modified for each institution based on available expertise, local barriers, and existing culture in the ICU to optimize evidence-based nutrition care for each critically ill patient.
重症患者通常无法维持足够的自主摄入量以满足其代谢需求。因此，提供营养是这些患者医疗护理的一部分。本综述详细介绍并解读了有关重症患者特殊营养治疗的当前数据，重点关注最近发表的研究。
作者通过文献检索、与重症护理营养专家的个人联系以及对未发表数据的了解来进行本综述。
对已发表和未发表的营养研究进行综述，包括观察性研究和随机对照试验。
作者通过共识来总结特殊营养背后的证据。
此外，作者为重症患者的营养护理提供建议。
目前的证据表明，在急性复苏努力后尽快开始肠内营养，可能具有提供热量和蛋白质之外的治疗作用。尽管许多新研究进一步推进了我们在该领域的知识，但营养治疗尚未达到其他重症护理领域所实现的适当标准化水平。应根据各机构现有的专业知识、当地障碍以及重症监护病房的现有文化，对标准化营养治疗方案进行调整，以优化对每位重症患者的循证营养护理。
