Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Division of General Surgery, Oregon Health Sciences University, Portland, Oregon, USA.
JPEN J Parenter Enteral Nutr. 2018 Mar;42(3):508-515. doi: 10.1177/0148607117721908. Epub 2017 Dec 12.
Over the past few years, numerous studies have called into question the optimal dose, timing, composition, and advancement rate of nutrition during the early acute phase of critical illness. These studies suggest permissive underfeeding with slow advancement may be more beneficial than aggressive full feeding. These counterintuitive results were possibly explained by enhanced autophagy, less hyperglycemia, or prevention of refeeding syndrome. This review underscores the controversies surrounding permissive underfeeding, aims to answer whether permissive underfeeding is appropriate for all critically ill patients, describes the impact of optimal protein delivery on critical care outcomes, discusses nutrition risk, and cogitates on the impact of nutrition on critical care outcomes.
在过去的几年中，许多研究对重症疾病早期阶段的营养最佳剂量、时间、组成和推进速度提出了质疑。这些研究表明，与积极的全喂养相比，允许性低喂养和缓慢推进可能更有益。这些有违直觉的结果可能是通过增强自噬、减少高血糖或预防再喂养综合征来解释的。这篇综述强调了允许性低喂养的争议，旨在回答允许性低喂养是否适用于所有重症患者，描述了最佳蛋白质输送对重症监护结果的影响，讨论了营养风险，并思考了营养对重症监护结果的影响。
