Intensive Care Department, MC 1425, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
Laboratory and Clinical Department of Intensive Care Medicine, Catholic University Leuven, Leuven, Belgium.
Intensive Care Med. 2017 Sep;43(9):1239-1256. doi: 10.1007/s00134-017-4711-6. Epub 2017 Apr 3.
The objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years.
Recent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism. Then, members of the panel rated each one of the topics using a grading system (0-4). Potential studies were ranked on the basis of average score.
Recent randomized controlled trials (RCTs) have challenged several concepts, including the notion that energy expenditure must be met universally in all critically ill patients during the acute phase of critical illness, the routine monitoring of gastric residual volume, and the value of immune-modulating nutrition. The optimal protein dose combined with standardized active and passive mobilization during the acute phase and post-acute phase of critical illness were the top ranked studies for the next 10 years. Nutritional assessment, nutritional strategies in critically obese patients, and the effects of continuous versus intermittent enteral nutrition were also among the highest-ranking studies.
Priorities for clinical research in the field of nutritional management of critically ill patients were suggested, with the prospect that different nutritional interventions targeted to the appropriate patient population will be examined for their effect on facilitating recovery and improving survival in adequately powered and properly designed studies, probably in conjunction with physical activity.
本次综述的目的在于总结当前重症监护营养和代谢的实践现状和主要的最新进展，回顾近期临床试验所反驳的一些常见观点，强调关键的尚存疑问领域，并针对未来 10 年应开展的 10 项顶级研究/试验提出建议。
对近期文献进行了回顾，总结了进展和知识空白。专家组确定了重症监护营养和代谢领域未来临床试验的候选主题。然后，专家组的成员使用分级系统（0-4）对每个主题进行评分。根据平均得分对潜在研究进行排名。
近期的随机对照试验（RCT）挑战了一些概念，包括在重症疾病的急性期，普遍认为所有危重患者的能量消耗都必须得到满足、常规监测胃残余量和免疫调节营养的价值。在重症疾病的急性期和康复期，最佳蛋白质剂量与标准化主动和被动运动相结合是未来 10 年排名最高的研究。营养评估、重症肥胖患者的营养策略以及连续与间歇性肠内营养的效果也属于排名最高的研究之列。
为重症患者营养管理领域的临床研究提出了优先事项，预计针对特定患者人群的不同营养干预措施将在充分设计和实施的研究中，评估其对促进康复和提高生存率的效果，可能会与身体活动相结合。
