Royal Prince Alfred Hospital, Sydney, Australia.
University of Sydney, Sydney, Australia.
Nutr Clin Pract. 2018 Feb;33(1):133-146. doi: 10.1177/0884533617706312. Epub 2017 Dec 14.
Nutrition monitoring in the context of critical care presents unique challenges. Traditionally used anthropometric and biochemical markers may be difficult to obtain or confounded by factors such as fluid status and the inflammatory response. A previous survey identified 15 parameters in common use, all of which have confounding influences during critical illness.
A literature search was conducted to assess current use of commonly used nutrition-monitoring parameters and to explore other possible methods that might be more useful. More than 1000 journal articles were reviewed to identify indicators of nutrition status or nutrition progress that have been used in ICU studies. The most recent 200 articles were examined to quantify the number of occurrences for each indicator. Each parameter was rated for availability and feasibility in the ICU.
There were 53 parameters found, including the 15 already identified as commonly used; 27 were used in ≥3 recent studies. Less-well-established nutrition indicators with potential for use in the ICU (moderate or high feasibility and availability) included ultrasound measurement of arm or leg muscle thickness, fatigue scoring with the Chalder scale, urinary creatinine assay, and serum insulin-like growth factor 1 level. None of these was among the commonly used indicators in recent studies.
This study identifies commonly used nutrition-monitoring parameters and discusses their feasibility and availability in the critical care setting. Further investigation of nutrition indicators in ICU is needed, ideally as part of a randomized trial to reduce the effect of the many possible confounding factors.
在重症监护环境下进行营养监测存在独特的挑战。传统上使用的人体测量学和生化标志物可能难以获得，或者受到液体状态和炎症反应等因素的干扰。之前的一项调查确定了 15 个常用参数，这些参数在重症疾病期间都会受到干扰。
进行了文献检索，以评估常用营养监测参数的当前使用情况，并探索其他可能更有用的方法。查阅了 1000 多篇期刊文章，以确定在 ICU 研究中使用的营养状况或营养进展的指标。检查了最近的 200 篇文章，以量化每个指标的出现次数。每个参数的 ICU 可用性和可行性进行了评分。
共发现 53 个参数，包括之前已确定为常用的 15 个参数；27 个参数在≥3 项近期研究中使用。一些不太成熟的营养指标也具有在 ICU 中使用的潜力（中等或高度可行性和可用性），包括手臂或腿部肌肉厚度的超声测量、使用 Chalder 量表进行疲劳评分、尿肌酐测定和血清胰岛素样生长因子 1 水平。这些都不是最近研究中常用的指标之一。
本研究确定了常用的营养监测参数，并讨论了它们在重症监护环境中的可行性和可用性。需要进一步研究 ICU 中的营养指标，理想情况下作为随机试验的一部分，以减少许多可能的混杂因素的影响。
