Department of Anesthesiology, Intensive Medicine and Pain Therapy, University Hospital Würzburg, Germany.
Department of Intensive Care Medicine and Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
Clin Nutr ESPEN. 2020 Dec;40:92-100. doi: 10.1016/j.clnesp.2020.09.006. Epub 2020 Sep 22.
Appropriate nutritional support is a key component of care for critically ill patients. While malnutrition increases complications, impacting long term outcomes and healthcare-related costs, uncertainties persist regarding optimal provision of nutritional support in this setting.
An international group of healthcare providers (HCPs) from critical care specialties and nutrition researchers convened to identify knowledge gaps and learnings from studies in critical care nutrition. Clinical research needs were identified in order to better inform future nutrition practices.
Challenges in critical care nutrition arise, in part, from inconsistent outcomes in several large-scale studies regarding the optimal amount of calories and protein to prescribe, the optimal time to initiate nutritional support and the role of parental nutrition to support critically ill patients. Furthermore, there is uncertainty on how best to identify patients at nutritional risk, and the appropriate outcome measures for ICU nutrition studies. Given HCPs have a suboptimal evidence base to inform the nutritional management of critically ill patients, further well-designed clinical trials capturing clinically relevant endpoints are needed to address these knowledge gaps.
The identified aspects for future research could be addressed in studies designed and conducted in collaboration with an international team of interdisciplinary nutrition experts. The aim of this collaboration is to address the unmet need for robust clinical data needed to develop high-quality evidence-based nutritional intervention recommendations to better inform the future management of critically ill patients.
适当的营养支持是危重症患者护理的关键组成部分。虽然营养不良会增加并发症,影响长期预后和医疗保健相关成本,但在这一领域,提供最佳营养支持的方法仍存在不确定性。
来自重症监护专业的国际医疗保健提供者(HCP)和营养研究人员组成的一个小组,旨在确定重症营养研究中的知识空白和经验教训。确定临床研究需求,以便更好地为未来的营养实践提供信息。
危重症营养方面的挑战部分源于几项大型研究中关于规定热量和蛋白质最佳剂量、启动营养支持的最佳时间以及父母营养支持危重症患者的作用等方面的结果不一致。此外,如何最好地识别有营养风险的患者以及 ICU 营养研究的适当结果衡量标准也存在不确定性。鉴于 HCP 为危重症患者提供营养管理的证据基础欠佳,需要进一步进行设计良好的临床试验,以获取更具临床相关性的终点数据,以解决这些知识空白。
未来研究可以针对确定的方面展开,这些方面的研究将与国际跨学科营养专家团队合作进行设计和开展。该合作的目的是解决对高质量循证营养干预建议的迫切需求,为未来危重症患者的管理提供更好的信息。