Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands.
Curr Opin Crit Care. 2018 Aug;24(4):223-227. doi: 10.1097/MCC.0000000000000519.
To summarize the most recent advances in acute metabolic care and critical care nutrition.
Recent research has demonstrated unknown consequences of high protein and amino acid administration in the early phase of ICU stay associated with dysregulated glucagon release leading to hepatic amino acid breakdown and suggested adverse effects on autophagy and long-term outcome. Progress has been made to measure body composition in the ICU. Refeeding hypophosphatemia and refeeding syndrome are common during critical illness, phosphate monitoring is essential after the start of nutrition therapy, and caloric restriction is recommendable in these patients.In recent studies, enteral nutrition is no longer superior to parenteral nutrition and signals of harm using the enteral route in shock have been suggested. However, during extracorporeal life support, enteral nutrition seems well tolerated. Intermittent or bolus enteral feeding seems an exciting concept concerning its potential anabolic effects. Studies on vitamin C, thiamine, and corticosteroid combinations suggest potential to improve outcome.
These new findings will probably change the practice of metabolic and nutrition therapy in critical illness and challenge paradigms advocated for long.
总结急性代谢治疗和重症监护营养方面的最新进展。
最近的研究表明，ICU 入住早期高蛋白质和氨基酸给药与胰高血糖素释放失调有关，导致肝氨基酸分解，并可能对自噬和长期结果产生不良影响，但目前对此知之甚少。在 ICU 中已经取得了测量身体成分的进展。危重病期间常发生再喂养性低磷血症和再喂养综合征，营养治疗开始后必须监测磷，这些患者推荐热量限制。最近的研究表明，肠内营养不再优于肠外营养，并且经肠途径在休克中使用提示存在危害信号。然而，在体外生命支持期间，肠内营养似乎可以耐受。间歇性或推注肠内喂养似乎是一个令人兴奋的概念，因为它具有潜在的合成代谢作用。关于维生素 C、硫胺素和皮质类固醇联合应用的研究表明，有可能改善预后。
这些新发现可能会改变重症患者代谢和营养治疗的实践，并挑战长期以来倡导的模式。
