KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
Medical University of Graz, Division of Endocrinology and Diabetology, Department of Internal Medicine, Graz, Austria.
Clin Nutr. 2021 Feb;40(2):590-599. doi: 10.1016/j.clnu.2020.06.005. Epub 2020 Jun 14.
BACKGROUND & AIMS: Despite the presumed importance of preventing and treating micronutrient and mineral deficiencies, it is still not clear how to optimize measurement and administration in critically ill patients. In order to design future comparative trials aimed at optimizing micronutrient and mineral management, an important first step is to gain insight in the current practice of micronutrient, phosphate and magnesium monitoring and administration.
Within the metabolism-endocrinology-nutrition (MEN) section of the European Society of Intensive Care Medicine (ESICM), the micronutrient working group designed a survey addressing current practice in parenteral micronutrient and mineral administration and monitoring. Invitations were sent by the ESICM research department to all ESICM members and past members.
Three hundred thirty-four respondents completed the survey, predominantly consisting of physicians (321 [96.1%]) and participants working in Europe (262 [78.4%]). Eighty-one (24.3%) respondents reported to monitor micronutrient deficiencies through clinical signs and/or laboratory abnormalities, and 148 (44.3%) reportedly measure blood micronutrient concentrations on a routine basis. Two hundred ninety-two (87.4%) participants provided specific data on parenteral micronutrient supplementation, of whom 150 (51.4%) reported early administration of combined multivitamin and trace element preparations at least in selected patients. Among specific parenteral micronutrient preparations, thiamine (146 [50.0%]) was reported to be the most frequently administered micronutrient, followed by vitamin B complex (104 [35.6%]) and folic acid (86 [29.5%]). One hundred twenty (35.9%) and 113 (33.8%) participants reported to perform daily measurements of phosphate and magnesium, respectively, whereas 173 (59.2%) and 185 (63.4%) reported to routinely supplement these minerals parenterally.
The survey revealed a wide variation in current practices of micronutrient, phosphate and magnesium measurement and parenteral administration, suggesting a risk of insufficient prevention, diagnosis and treatment of deficiencies. These results provide the context for future comparative studies, and identify areas for knowledge translation and recommendations.
尽管预防和治疗微量营养素和矿物质缺乏症的重要性已被广泛认识，但目前仍不清楚如何优化危重症患者的测量和管理方法。为了设计旨在优化微量营养素和矿物质管理的未来比较性试验，重要的第一步是深入了解当前微量营养素、磷酸盐和镁监测和管理的实践情况。
在欧洲重症监护医学学会（ESICM）的新陈代谢-内分泌-营养（MEN）分会中，微量营养素工作组设计了一项调查，以了解目前肠外微量营养素和矿物质管理和监测的实际情况。ESICM 研究部门向所有 ESICM 成员和前成员发送了邀请。
334 名受访者完成了调查，主要由医生（321 [96.1%]）和在欧洲工作的参与者（262 [78.4%]）组成。81 名（24.3%）受访者报告通过临床症状和/或实验室异常监测微量营养素缺乏症，148 名（44.3%）受访者定期测量血液微量营养素浓度。292 名（87.4%）参与者提供了肠外微量营养素补充的具体数据，其中 150 名（51.4%）报告至少在某些患者中早期给予联合多种维生素和微量元素制剂。在特定的肠外微量营养素制剂中，硫胺素（146 [50.0%]）是报告中最常给予的微量营养素，其次是维生素 B 复合物（104 [35.6%]）和叶酸（86 [29.5%]）。120 名（35.9%）和 113 名（33.8%）参与者分别报告每天测量磷酸盐和镁，而 173 名（59.2%）和 185 名（63.4%）报告常规给予这些矿物质肠外补充。
调查显示，目前在微量营养素、磷酸盐和镁的测量和肠外给药方面存在广泛的差异，这表明存在预防、诊断和治疗不足的风险。这些结果为未来的比较研究提供了背景，并确定了知识转化和推荐的领域。
