Leguina-Ruzzi Alberto A, Ortiz Rina
Institute of Physiology AS CR, v.v.l., Department of Mitochondrial Physiology, Vídeňská 1083, 14220 Prague 4, Czech Republic.
Centro de Biotecnología, Universidad Técnica Federico Santa María, Avenida España, 1680 Valparaíso, Chile.
Crit Care Res Pract. 2018 Nov 21;2018:6301293. doi: 10.1155/2018/6301293. eCollection 2018.
There are strong data showing that malnutrition is highly prevalent in intensive care unit patients (20-50% in the worldwide), presenting a negative accumulated body energy balance. This results in an increased mortality, infections, and hospital length stay with high costs associated with the total treatment. Parenteral nutrition is the first option when the patient's physical condition is not suitable for oral nutrient intake. It is composed essentially by lipids as an energy source, metabolic, and structural function. However, these patients also require a mixture of essential and nonessential fatty acids (SMOF emulsions) to supply not only energy needs but also restore immunological, anti-inflammatory, and proregenerative functions. A revision of the safety and efficacy of Smoflipid® in patients requiring long-term parenteral nutrition was discussed here. Although controversial data are available indicating the contraindications or effectiveness of its use, most of studies presented indicate favorable benefits associated with improved clinical outcomes. The reported roles of this supplementation include positive immunomodulatory and anti-inflammatory effects, positive impact in liver function, reduction of hospital stay, and nosocomial infections as additional contributions to its energetic role, which in many cases results in reduced total costs per patient. Finally, many authors propose that the use of Smoflipid® should become a gold standard of parenteral nutrition in intensive unit care patients and that the costs associated with this supplement should not be limiting for its use, not only to improve the clinical outcome but also to reduce the treatment costs.
有确凿数据表明，营养不良在重症监护病房患者中极为普遍（全球范围内为20%-50%），呈现出机体能量负平衡。这导致死亡率增加、感染风险上升、住院时间延长，且总治疗成本高昂。当患者身体状况不适合经口摄入营养时，肠外营养是首选。它主要由脂质构成，作为能量来源，具有代谢和结构功能。然而，这些患者还需要必需脂肪酸和非必需脂肪酸的混合物（SMOF乳剂），不仅要满足能量需求，还要恢复免疫、抗炎和促再生功能。本文讨论了Smoflipid®在需要长期肠外营养的患者中的安全性和有效性。尽管有争议的数据表明其使用存在禁忌或有效性存疑，但大多数现有研究表明其与改善临床结局相关的有益作用。这种补充剂的作用包括积极的免疫调节和抗炎作用、对肝功能的积极影响、缩短住院时间以及减少医院感染，这些都是其能量作用之外的额外贡献，在许多情况下可降低每位患者的总成本。最后，许多作者提议，Smoflipid®的使用应成为重症监护病房患者肠外营养的金标准，且与这种补充剂相关的成本不应限制其使用，这不仅有助于改善临床结局，还能降低治疗成本。
