McClave Stephen A, Weijs Peter J M
aDepartment of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA bDepartments of Nutrition and Dietetics, Internal medicine, and Intensive Care Medicine, Vu University Medical Center and Department of Nutrition and Dietetics, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
Curr Opin Clin Nutr Metab Care. 2015 Mar;18(2):155-61. doi: 10.1097/MCO.0000000000000144.
Recent reports in the literature have proposed that forced mandatory feeding should be avoided in the first week of critical illness to preserve autophagy, in order to maximize responses to oxidative stress, preserve organ function, and improve outcomes.
Autophagy is a well recognized physiologic process that serves a housekeeping role for the cell to eliminate large protein aggregates and as a survival mechanism in starvation for generating energy (ATP) and promoting protein synthesis to maintain cell structure. In the critical care setting, autophagy may have important roles in modulating immune function, fighting infection, and preventing organ failure. The effect of feeding on autophagy is complex, poorly understood, and difficult to predict.
The argument to withhold feeding to preserve autophagy is poorly substantiated and should not interfere with the delivery of early enteral nutrition to the critically ill patient in that first week following admission to the ICU.
文献中的近期报告提出，在危重病的第一周应避免强制鼻饲，以维持自噬，从而最大程度地提高对氧化应激的反应、维持器官功能并改善预后。
自噬是一种广为人知的生理过程，它在细胞中发挥清理作用，清除大的蛋白质聚集体，并且在饥饿状态下作为一种生存机制，用于产生能量（三磷酸腺苷）和促进蛋白质合成以维持细胞结构。在重症监护环境中，自噬可能在调节免疫功能、抵抗感染和预防器官衰竭方面发挥重要作用。喂养对自噬的影响复杂，了解不足且难以预测。
为维持自噬而不进行喂养的观点证据不足，不应干扰在重症监护病房（ICU）入院后的第一周为危重病患者提供早期肠内营养。
