Department of Intensive Care Medicine, Medical Faculty RWTH Aachen, Aachen, Germany.
3CARE-Cardiovascular Critical Care & Anaesthesia Evaluation and Research, Medical Faculty RWTH Aachen, Aachen, Germany.
Nutr Res Rev. 2020 Dec;33(2):312-320. doi: 10.1017/S0954422420000165. Epub 2020 Jul 16.
While medical nutrition therapy is an essential part of the care for critically ill patients, uncertainty exists about the right form, dosage, timing and route in relation to the phases of critical illness. As enteral nutrition (EN) is often withheld or interrupted during the intensive care unit (ICU) stay, combined EN and parenteral nutrition (PN) may represent an effective and safe option to achieve energy and protein goals as recommended by international guidelines. We hypothesise that critically ill patients at high nutritional risk may benefit from such a combined approach during their stay on the ICU. Therefore, we aim to test if an early combination of EN and high-protein PN (EN+PN) is effective in reaching energy and protein goals in patients at high nutritional risk, while avoiding overfeeding. This approach will be tested in the here-presented EFFORTcombo trial. Nutritionally high-risk ICU patients will be randomised to either high (≥2·2 g/kg per d) or low protein (≤1·2 g/kg per d). In the high protein group, the patients will receive EN+PN; in the low protein group, patients will be given EN alone. EN will be started in accordance with international guidelines in both groups. Efforts will be made to reach nutrition goals within 48-96 h. The efficacy of the proposed nutritional strategy will be tested as an innovative approach by functional outcomes at ICU and hospital discharge, as well as at a 6-month follow-up.
虽然医学营养疗法是危重症患者治疗的重要组成部分，但在与危重症阶段相关的形式、剂量、时间和途径方面仍存在不确定性。由于肠内营养（EN）在重症监护病房（ICU）期间经常被停止或中断，因此联合 EN 和肠外营养（PN）可能是实现国际指南推荐的能量和蛋白质目标的有效和安全选择。我们假设高营养风险的危重症患者在 ICU 住院期间可能受益于这种联合治疗方法。因此，我们旨在测试高营养风险患者早期联合 EN 和高蛋白 PN（EN+PN）是否能有效达到能量和蛋白质目标，同时避免过度喂养。这种方法将在本研究的 EFFORTcombo 试验中进行测试。营养高风险的 ICU 患者将被随机分配到高蛋白（≥2.2 g/kg/d）或低蛋白（≤1.2 g/kg/d）组。在高蛋白组中，患者将接受 EN+PN；在低蛋白组中，患者将接受单独的 EN。两组均按照国际指南开始 EN。将努力在 48-96 小时内达到营养目标。通过 ICU 和出院时以及 6 个月随访时的功能结局，将对所提议的营养策略的疗效进行测试，作为一种创新方法。
