Hurt Ryan T, McClave Stephen A, Martindale Robert G, Ochoa Gautier Juan B, Coss-Bu Jorge A, Dickerson Roland N, Heyland Daren K, Hoffer L John, Moore Frederick A, Morris Claudia R, Paddon-Jones Douglas, Patel Jayshil J, Phillips Stuart M, Rugeles Saúl J, Sarav Md Menaka, Weijs Peter J M, Wernerman Jan, Hamilton-Reeves Jill, McClain Craig J, Taylor Beth
1 Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
2 Department of Medicine, University of Louisville, Louisville, Kentucky, USA.
Nutr Clin Pract. 2017 Apr;32(1_suppl):142S-151S. doi: 10.1177/0884533617693610.
The International Protein Summit in 2016 brought experts in clinical nutrition and protein metabolism together from around the globe to determine the impact of high-dose protein administration on clinical outcomes and address barriers to its delivery in the critically ill patient. It has been suggested that high doses of protein in the range of 1.2-2.5 g/kg/d may be required in the setting of the intensive care unit (ICU) to optimize nutrition therapy and reduce mortality. While incapable of blunting the catabolic response, protein doses in this range may be needed to best stimulate new protein synthesis and preserve muscle mass. Quality of protein (determined by source, content and ratio of amino acids, and digestibility) affects nutrient sensing pathways such as the mammalian target of rapamycin. Achieving protein goals the first week following admission to the ICU should take precedence over meeting energy goals. High-protein hypocaloric (providing 80%-90% of caloric requirements) feeding may evolve as the best strategy during the initial phase of critical illness to avoid overfeeding, improve insulin sensitivity, and maintain body protein homeostasis, especially in the patient at high nutrition risk. This article provides a set of recommendations based on assessment of the current literature to guide healthcare professionals in clinical practice at this time, as well as a list of potential topics to guide investigators for purposes of research in the future.
2016年国际蛋白质峰会汇聚了全球临床营养和蛋白质代谢领域的专家，以确定高剂量蛋白质给药对临床结局的影响，并解决在重症患者中实施该疗法的障碍。有人提出，在重症监护病房（ICU）环境中，可能需要1.2 - 2.5克/千克/天范围内的高剂量蛋白质，以优化营养治疗并降低死亡率。虽然无法抑制分解代谢反应，但可能需要此范围内的蛋白质剂量来最佳地刺激新蛋白质合成并维持肌肉质量。蛋白质质量（由来源、氨基酸含量和比例以及消化率决定）会影响营养感应途径，如雷帕霉素靶蛋白。在入住ICU后的第一周实现蛋白质目标应优先于实现能量目标。高蛋白低热量（提供80% - 90%的热量需求）喂养可能会成为危重病初始阶段的最佳策略，以避免过度喂养、提高胰岛素敏感性并维持身体蛋白质稳态，尤其是对于高营养风险患者。本文基于对当前文献的评估提供了一系列建议，以指导医疗保健专业人员目前的临床实践，同时还列出了一系列潜在主题，以指导研究人员未来的研究方向。
