aDepartment of Intensive Care Medicine bDepartment of Nutrition and Dietetics, Internal Medicine cDepartment of Nutrition and Dietetics, Amsterdam University of Applied Sciences dInstitute for Cardiovascular Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
Curr Opin Crit Care. 2016 Aug;22(4):299-302. doi: 10.1097/MCC.0000000000000325.
Protein delivery in the critically ill still is a highly debated issue. Here, we discuss only the most recent updates in the literature concerning protein nutrition of the critically ill.
Up to now, there are no randomized controlled trials (RCTs) published on enteral provision of protein that were randomized for protein level of intake. In the past year, there have been two new observational studies published, one of which in critically ill children. Also, two randomized controlled trials with high parenteral amino acid provision have been published. The overall view on nutrition support has not been changed convincingly by these studies. Recent findings have confirmed that protein and amino acid provision are highly important for outcome in critically ill patients. For the first time, a randomized study confirmed this, however, only on the short term. The other RCT confirmed that an extreme dosing of amino acids is not related to improvement in outcome. One observational study showed that the effect of protein on outcome should be adjusted for energy intake and vice versa, showing that adequate protein is related to improved outcome and adequate energy provision is not. The other observational study confirmed importance of protein in paediatric ICU but also gained some insight into improvement of protein delivery by postpyloric feeding and usefulness of a dedicated dietitian in the ICU.
We will continue to improve protein delivery to critically ill patients; however, the quest for evidence and feeding guidelines still remains.
危重症患者的蛋白质输送仍是一个备受争议的问题。在这里，我们仅讨论有关危重症患者蛋白质营养的最新文献更新。
到目前为止，尚无关于摄入蛋白质水平随机分组的肠内提供蛋白质的随机对照试验（RCT）发表。在过去的一年中，发表了两项新的观察性研究，其中一项是在危重症儿童中进行的。此外，还发表了两项高肠外氨基酸供给的随机对照试验。这些研究并没有令人信服地改变对营养支持的总体看法。最近的研究结果证实，蛋白质和氨基酸的供给对危重症患者的预后非常重要。首次有一项随机研究证实了这一点，但只是在短期内。另一项 RCT 证实，极端剂量的氨基酸与改善预后无关。一项观察性研究表明，蛋白质对预后的影响应根据能量摄入进行调整，反之亦然，这表明充足的蛋白质与改善预后有关，而充足的能量供给则没有。另一项观察性研究证实了蛋白质在儿科 ICU 中的重要性，但也深入了解了通过幽门后喂养改善蛋白质输送的效果，以及 ICU 中专门营养师的作用。
我们将继续改善危重症患者的蛋白质输送，但仍需要寻求证据和喂养指南。
