Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede.
Wageningen University & Research, Division of Human Nutrition and Health, Wageningen, The Netherlands.
Curr Opin Crit Care. 2023 Apr 1;29(2):101-107. doi: 10.1097/MCC.0000000000001016. Epub 2023 Jan 27.
To summarize recent research on critical care nutrition focusing on the optimal composition, timing, and monitoring of enteral feeding strategies for (post)-ICU patients. We provide new insights on energy and protein recommendations, feeding intolerance, and describe nutritional practices for coronavirus disease 2019 ICU patients.
The use of indirect calorimetry to establish individual energy requirements for ICU patients is considered the gold standard. The limited research on optimal feeding targets in the early phase of critical illness suggests avoiding overfeeding. Protein provision based upon the absolute lean body mass is rational. Therefore, body composition measurements should be considered. Body impedance analysis and muscle ultrasound seem reliable, affordable, and accessible methods to assess body composition at the bedside. There is inadequate evidence to change our practice of continuous enteral feeding into intermittent feeding. Finally, severe acute respiratory syndrome coronavirus 2 patients are prone to underfeeding due to hypermetabolism and should be closely monitored.
Nutritional therapy should be adapted to the patient's characteristics, diagnosis, and state of metabolism during ICU stay and convalescence. A personalized nutrition plan may prevent harmful over- or underfeeding and attenuate muscle loss. Despite novel insights, more research is warranted into tailored nutrition strategies during critical illness and convalescence.
总结近期危重病营养研究进展，重点关注（术后）ICU 患者肠内喂养策略的最佳成分、时机和监测。我们提供有关能量和蛋白质推荐、喂养不耐受的新见解，并描述了 2019 年冠状病毒病 ICU 患者的营养实践。
使用间接热量法来确定 ICU 患者的个体能量需求被认为是金标准。在危重病早期确定最佳喂养目标的有限研究表明，避免过度喂养。基于去脂体重的蛋白质供给是合理的。因此，应考虑进行体成分测量。体阻抗分析和肌肉超声似乎是可靠、经济实惠且可在床边评估体成分的方法。没有足够的证据可以改变我们持续肠内喂养的做法为间歇性喂养。最后，由于代谢亢进，严重急性呼吸综合征冠状病毒 2 患者容易出现喂养不足，应密切监测。
营养治疗应根据 ICU 期间和恢复期患者的特点、诊断和代谢状态进行调整。个性化营养计划可能预防有害的过度或不足喂养，并减轻肌肉损失。尽管有新的见解，但仍需要对危重病和恢复期的个体化营养策略进行更多研究。
