Preiser Jean-Charles, van Zanten Arthur R H, Berger Mette M, Biolo Gianni, Casaer Michael P, Doig Gordon S, Griffiths Richard D, Heyland Daren K, Hiesmayr Michael, Iapichino Gaetano, Laviano Alessandro, Pichard Claude, Singer Pierre, Van den Berghe Greet, Wernerman Jan, Wischmeyer Paul, Vincent Jean-Louis
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 808 route de Lennik, Brussels, 1070, Belgium.
Department of Intensive Care, Gelderse Vallei Hospital, Willy Brandtlaan 10, Ede, Gld 6716RP, The Netherlands.
Crit Care. 2015 Jan 29;19(1):35. doi: 10.1186/s13054-015-0737-8.
The results of recent large-scale clinical trials have led us to review our understanding of the metabolic response to stress and the most appropriate means of managing nutrition in critically ill patients. This review presents an update in this field, identifying and discussing a number of areas for which consensus has been reached and others where controversy remains and presenting areas for future research. We discuss optimal calorie and protein intake, the incidence and management of re-feeding syndrome, the role of gastric residual volume monitoring, the place of supplemental parenteral nutrition when enteral feeding is deemed insufficient, the role of indirect calorimetry, and potential indications for several pharmaconutrients.
近期大规模临床试验的结果促使我们重新审视对重症患者应激代谢反应的理解以及管理营养的最合适方法。本综述介绍了该领域的最新情况,识别并讨论了已达成共识的一些领域以及仍存在争议的其他领域,并提出了未来的研究方向。我们讨论了最佳热量和蛋白质摄入量、再喂养综合征的发生率及管理、胃残余量监测的作用、当肠内喂养被认为不足时补充肠外营养的地位、间接测热法的作用以及几种营养药理学药物的潜在适应证。