Jiang Hua, Zhang Jian-Cheng, Zeng Jun, Wang Lu, Wang Yu, Lu Charles Damien, Deng Lei, Deng Hongfei, Wang Kai, Sun Ming-Wei, Zhou Ping, Yuan Ting, Chen Wei
Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China.
Emergency Intensive Care Unit, Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China.
Burns Trauma. 2020 Dec 21;8:tkaa048. doi: 10.1093/burnst/tkaa048. eCollection 2020.
There is little research that focuses on the relationship between the gut, metabolism, nutritional support and COVID-19. As a group of Chinese physicians, nutritionists and scientists working on the frontline treating COVID-19 patients, we aim to integrate our experiences and the current clinical evidence to address this pressing issue in this article. Based on our clinical observations and available evidence, we recommend the following practice. Firstly, the Nutritional Risk Screening 2002 tool should be used routinely and periodically; for patients with a score ≥3, oral nutritional supplements should be given immediately. Secondly, for patients receiving the antiviral agents lopinavir/ritonavir, gastrointestinal side effects should be monitored for and timely intervention provided. Thirdly, for feeding, the enteral route should be the first choice. In patients undergoing mechanical ventilation, establishing a jejunal route as early as possible can guarantee the feeding target being achieved if gastric dilatation occurs. Fourthly, we suggest a permissive underfeeding strategy for severe/critical patients admitted to the intensive care unit during the first week of admission, with the energy target no more than 20 kcal/kg/day (for those on mechanical ventilation, this target may be lowered to 10-15 kcal/kg/day) and the protein target around 1.0-1.2 g/kg/day. If the inflammatory condition is significantly alleviated, the energy target may be gradually increased to 25-30 kcal/kg/day and the protein target to 1.2-1.5 g/kg/day. Fifthly, supplemental parenteral nutrition should be used with caution. Lastly, omega-3 fatty acids may be used as immunoregulators, intravenous administration of omega-3 fatty emulsion (10 g/day) at an early stage may help to reduce the inflammatory reaction.
很少有研究关注肠道、代谢、营养支持与新型冠状病毒肺炎(COVID-19)之间的关系。作为一组奋战在治疗COVID-19患者一线的中国医生、营养学家和科学家,我们旨在整合我们的经验和当前的临床证据,在本文中解决这一紧迫问题。基于我们的临床观察和现有证据,我们建议如下做法。首先,应常规且定期使用2002年营养风险筛查工具;对于评分≥3分的患者,应立即给予口服营养补充剂。其次,对于接受抗病毒药物洛匹那韦/利托那韦治疗的患者,应监测胃肠道副作用并及时进行干预。第三,对于喂养,肠内途径应作为首选。在接受机械通气的患者中,如果发生胃扩张,尽早建立空肠途径可确保实现喂养目标。第四,我们建议对入住重症监护病房的重症/危重症患者在入院第一周采取允许性低热量喂养策略,能量目标不超过20千卡/千克/天(对于接受机械通气的患者,该目标可降至10 - 15千卡/千克/天),蛋白质目标约为1.0 - 1.2克/千克/天。如果炎症状况明显缓解,能量目标可逐渐增加至25 - 30千卡/千克/天,蛋白质目标增加至1.2 - 1.5克/千克/天。第五,应谨慎使用补充性肠外营养。最后,ω-3脂肪酸可作为免疫调节剂使用,早期静脉输注ω-3脂肪乳剂(10克/天)可能有助于减轻炎症反应。