Heyland Daren K, Weijs Peter J M, Coss-Bu Jorge A, Taylor Beth, Kristof Arnold S, O'Keefe Grant E, Martindale Robert G
1 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
2 Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
Nutr Clin Pract. 2017 Apr;32(1_suppl):58S-71S. doi: 10.1177/0884533617691245. Epub 2017 Mar 1.
Emerging evidence suggests that exogenous protein/amino acid supplementation has the potential to improve the recovery of critically ill patients. After a careful review of the published evidence, experts have concluded that critically ill patients should receive up to 2.0-2.5 g/kg/d of protein. Despite this, however, recent review of current International Nutrition Survey data suggests that protein in critically ill patients is underprescribed and grossly underdelivered. Furthermore, the survey suggests that most of protein administration comes from enteral nutrition (EN) despite the availability of products and protocols that enhance the delivery of protein/amino acids in the intensive care unit (ICU) setting. While future research clarifies the dose, timing, and composition for exogenous protein administration, as well as identification of patients who will benefit the most, ongoing process improvement initiatives should target a concerted effort to increase protein intake in the critically ill. This assertion follows from the notion that current patients are possibly being harmed while we wait for confirmatory evidence. Further research should also develop better tools to enable bedside practitioners to monitor optimal or adequate protein intake for individual patients. Finally, exploring the effect of combining adequate protein delivery with early mobility and/or resistance exercise in the ICU setting has the greatest potential for improving the functional outcomes of survivors of critical illness and warrants further study.
新出现的证据表明，补充外源性蛋白质/氨基酸有可能改善重症患者的康复情况。在仔细审查已发表的证据后，专家得出结论，重症患者应摄入高达2.0 - 2.5克/千克/天的蛋白质。然而，尽管如此，最近对当前国际营养调查数据的审查表明，重症患者的蛋白质处方不足且供应严重不足。此外，该调查表明，尽管有产品和方案可在重症监护病房（ICU）环境中增加蛋白质/氨基酸的供应，但大多数蛋白质供应来自肠内营养（EN）。虽然未来的研究将明确外源性蛋白质给药的剂量、时间和组成，以及确定最受益的患者，但正在进行的流程改进举措应共同努力，以增加重症患者的蛋白质摄入量。这一主张源于这样一种观念，即目前在等待确凿证据的过程中，患者可能正在受到伤害。进一步的研究还应开发更好的工具，使床边医生能够监测个体患者的最佳或充足蛋白质摄入量。最后，探索在ICU环境中将充足的蛋白质供应与早期活动和/或抗阻运动相结合的效果，对于改善危重症幸存者的功能结局具有最大潜力，值得进一步研究。
