Department of Intensive Care Medicine and Department of Nutrition, UZ Brussel, Vrije Unversiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
Medical Affairs, Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA.
Clin Nutr. 2021 May;40(5):2958-2973. doi: 10.1016/j.clnu.2020.12.032. Epub 2020 Dec 29.
Nutrition therapy, by enteral, parenteral, or both routes combined, is a key component of the management of critically ill, surgical, burns, and oncology patients. Established evidence indicates overfeeding (provision of excessive calories) results in increased risk of infection, morbidity, and mortality. This has led to the practice of "permissive underfeeding" of calories; however, this can often lead to inadequate provision of guideline-recommended protein intakes. Acutely ill patients requiring nutritional therapy have high protein requirements, and studies demonstrate that provision of adequate protein can result in reduced mortality and improvement in quality of life. However, a significant challenge to adequate protein delivery is the current lack of concentrated protein solutions. Patients often have fluid administration restrictions and existing protein solutions are frequently not sufficiently concentrated to deliver a patient's protein requirements. This has led to the development of new enteral and parenteral nutrition solutions incorporating higher levels of protein in smaller volumes. This review article summarizes current evidence supporting the role of higher protein intakes, especially during the early phases of nutrition therapy in acute illness, methods for assessing protein requirements, as well as, the currently available high-protein enteral and parenteral nutrition solutions. There is sufficient evidence (albeit limited from true randomized, controlled studies) to indicate that earlier provision of guideline-recommended protein intakes may be key to improving patient outcomes and that nutritional therapy that tailors caloric and protein intake to the patients' needs should be considered a desired standard of care.
营养治疗，无论是通过肠内、肠外途径，还是两者结合，都是危重症、外科、烧伤和肿瘤患者治疗的关键组成部分。已有的证据表明，过度喂养（提供过多的热量）会增加感染、发病率和死亡率的风险。这导致了“允许性低喂养”的做法；然而，这往往会导致指南推荐的蛋白质摄入量不足。需要营养治疗的急性病患者蛋白质需求量高，研究表明提供足够的蛋白质可以降低死亡率并提高生活质量。然而，充足蛋白质输送的一个重大挑战是目前缺乏浓缩蛋白质溶液。患者通常有液体摄入限制，并且现有的蛋白质溶液通常不够浓缩，无法满足患者的蛋白质需求。这导致了新的肠内和肠外营养溶液的开发，这些溶液在较小的体积中包含更高水平的蛋白质。本文综述了目前支持更高蛋白质摄入量的作用的证据，特别是在急性疾病的营养治疗早期阶段，评估蛋白质需求的方法，以及目前可用的高蛋白肠内和肠外营养溶液。有足够的证据（尽管有限，来自真正的随机对照研究）表明，更早地提供指南推荐的蛋白质摄入量可能是改善患者预后的关键，而根据患者的需求调整热量和蛋白质摄入量的营养治疗应被视为理想的护理标准。
