Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
Harborview Medical Center, Seattle, Washington, USA.
Nutr Clin Pract. 2019 Oct;34(5):751-759. doi: 10.1002/ncp.10256. Epub 2019 Feb 7.
Published guidelines recommend providing at least 2 g/kg/d of protein for critically ill surgical patients. It may be difficult to achieve this level of intake using standard enteral formulas, thus necessitating protein or amino acid supplementation. Herein, we report our approach to enteral protein supplementation and its relationship with urinary nitrogen excretion and serum transthyretin concentrations.
This was a retrospective cohort study in which we reviewed critically ill trauma and surgical patients treated with supplemental enteral protein according to a protocol aiming to deliver a total of 2 g/kg/d of protein. We collected detailed nutrition data over a 2-week period after admission and obtained additional data through discharge to determine caloric and protein intake as well as complications. We also compared urine nitrogen excretion and transthyretin concentrations between these patients and a control group who did not receive supplemental protein.
Fifty-three subjects received early protein supplementation. Formula and protein supplement each provided ≈1.2 g/kg/d of protein by intensive care unit day 4. This resulted in a median total protein intake of 2.2 g/kg/d through day 14. One patient developed acute kidney injury, and 1 patient had 3 episodes of vomiting. By the third week, serum transthyretin concentrations increased to a median of 21 mg/dL compared with 13 mg/dL in subjects not receiving early supplementation.
It is safe to deliver supplemental protein enterally to critically ill surgical and trauma patients and reach 2 g/kg/d of protein intake during the first week of illness.
已发表的指南建议为重症外科患者提供至少 2g/kg/d 的蛋白质。使用标准肠内配方可能难以达到此摄入水平，因此需要补充蛋白质或氨基酸。本文报告了我们肠内蛋白质补充的方法及其与尿氮排泄和血清转甲状腺素蛋白浓度的关系。
这是一项回顾性队列研究，我们对根据旨在提供总共 2g/kg/d 蛋白质的方案接受补充肠内蛋白质的重症创伤和外科患者进行了回顾。我们在入院后 2 周内收集了详细的营养数据，并通过出院获得了其他数据，以确定热量和蛋白质的摄入以及并发症。我们还比较了这些患者与未接受补充蛋白质的对照组的尿氮排泄和转甲状腺素蛋白浓度。
53 名患者接受了早期蛋白质补充。到第 4 天重症监护病房，配方和蛋白质补充剂各自提供了 ≈1.2g/kg/d 的蛋白质。这导致在第 14 天之前中位数总蛋白质摄入量为 2.2g/kg/d。1 名患者发生急性肾损伤，1 名患者发生 3 次呕吐。到第三周，血清转甲状腺素蛋白浓度增加至中位数 21mg/dL，而未接受早期补充的患者为 13mg/dL。
向重症外科和创伤患者肠内给予补充蛋白质并在患病的第一周达到 2g/kg/d 的蛋白质摄入量是安全的。
