Patel Jayshil J, Shukla Anuj, Heyland Daren K
Department of Medicine, Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
JPEN J Parenter Enteral Nutr. 2021 Nov;45(S2):74-78. doi: 10.1002/jpen.2246.
Septic shock is a public health burden and defined as a subset of sepsis whereby abnormalities in microcirculatory and cellular metabolism manifest as acute circulatory failure. At the level of the gut, septic shock impairs epithelial barrier function (EBF), and the gut initiates proinflammatory responses contributing to multiple organ dysfunction syndrome. The timing and dose of enteral nutrition (EN) in septic shock remains a conundrum. On the one hand, early EN preserves EBF. On the other hand, serious gastrointestinal complications such as bowel necrosis may limit EN initiation in septic shock. We (1) describe the pathophysiologic conundrum septic shock poses for EN initiation, (2) outline guideline-based recommendations for EN in septic shock, (3) identify the role of parenteral nutrition in septic shock, and (4) identify and appraise postguideline literature on the timing, dose, and titration of EN in septic shock.
脓毒性休克是一种公共卫生负担，被定义为脓毒症的一个子集，其中微循环和细胞代谢异常表现为急性循环衰竭。在肠道层面，脓毒性休克会损害上皮屏障功能（EBF），并且肠道会引发促炎反应，导致多器官功能障碍综合征。脓毒性休克患者肠内营养（EN）的时机和剂量仍然是一个难题。一方面，早期肠内营养可维持上皮屏障功能。另一方面，诸如肠坏死等严重的胃肠道并发症可能会限制脓毒性休克患者开始肠内营养。我们（1）描述脓毒性休克在开始肠内营养方面所带来的病理生理难题，（2）概述基于指南的脓毒性休克肠内营养建议，（3）确定肠外营养在脓毒性休克中的作用，以及（4）识别和评估关于脓毒性休克肠内营养的时机、剂量和滴定的指南后文献。
