Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands.
Curr Opin Crit Care. 2018 Aug;24(4):235-240. doi: 10.1097/MCC.0000000000000514.
To provide an overview of recent findings concerning refeeding syndrome (RFS) among critically ill patients and recommendations for daily practice.
Recent literature shows that RFS is common among critically ill ventilated patients. Usual risk factors for non-ICU patients addressed on ICU admission do not identify patients developing RFS. A marked drop of phosphate levels (>0.16 mmol/l) from normal levels within 72 h of commencement of feeding, selects patients that benefit from hypocaloric or restricted caloric intake for at least 48 h resulting in lower long-term mortality.
RFS is a potentially life-threatening condition induced by initiation of feeding after a period of starvation. Although a uniform definition is lacking, most definitions comprise a complex constellation of laboratory markers (i.e. hypophosphatemia, hypokalemia, hypomagnesemia) or clinical symptoms, including cardiac and pulmonary failure. Recent studies show that low caloric intake results in lower mortality rates in critically ill RFS patients compared with RFS patients on full nutritional support. Therefore, standard monitoring of RFS-markers (especially serum phosphate) and caloric restriction when RFS is diagnosed should be considered. Furthermore, standard therapy with thiamin and electrolyte supplementation is essential.
提供最近有关危重症患者再喂养综合征（RFS）的发现，并为日常实践提供建议。
最近的文献表明，RFS 在接受机械通气的危重症患者中很常见。通常在 ICU 入院时针对非 ICU 患者的风险因素并不能识别出发生 RFS 的患者。在开始喂养后 72 小时内，磷酸盐水平从正常水平明显下降（>0.16mmol/l），这有助于选择至少 48 小时接受低热量或限制热量摄入的患者，从而降低长期死亡率。
RFS 是由饥饿期后开始喂养引起的潜在危及生命的情况。尽管缺乏统一的定义，但大多数定义都包括一系列实验室标志物（即低磷血症、低钾血症、低镁血症）或临床症状，包括心脏和肺衰竭。最近的研究表明，与接受全营养支持的 RFS 患者相比，低热量摄入可降低危重症 RFS 患者的死亡率。因此，应考虑在诊断 RFS 时监测 RFS 标志物（尤其是血清磷酸盐）和热量限制，并应考虑进行标准治疗，包括补充维生素 B1 和电解质。
