Medeiros Rita P, Ramos de Sousa Ricardo Filipe, Santos Silva Mariana, Rego Rita, Torrao Cristina, Amaral Inês M, Pereira Rita, Pinho João P, Sousa Marinho Ricardo C, Sousa Marinho Aníbal D
Intensive Care Unit, Centro Hospitalar Universitário do Porto (CHUP), Porto, PRT.
Family Medicine, Unidade de Saúde Familiar (USF) Terras de Souza, Porto, PRT.
Cureus. 2023 Jan 20;15(1):e33999. doi: 10.7759/cureus.33999. eCollection 2023 Jan.
The nutritional needs of critically ill patients have been the subject of intense controversy. In accordance with international guidelines, it is advocated to optimize a nutritional intake based on the following recommendation: 25-30 kcal/kg body weight per day. However, there still are authors who recommend permissive underfeeding in the first week of hospitalization. Nevertheless, energy expenditure (EE) and necessity are influenced by the catabolic phase of critical illness, which may vary over time on a patient and from patient to patient.
The objective of this study is to assess if the energy needs of critically ill patients admitted in our intensive care unit (ICU) in the first week of hospitalization are in line with those recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) international guidelines.
A prospective cross-sectional study was carried out from September to December 2019. The energy needs were evaluated by indirect calorimetry and by the Harris-Benedict equation. Stress variables were evaluated, namely, the type of pathology, hemodynamic support, sedation, temperature, sequential organ failure assessment (SOFA) score, and state at discharge.
Forty-six patients were included in this study, with an average energy expenditure by indirect calorimetry of 19.22 ± 4.67 kcal/kg/day. The energy expenditure was less than 20 kcal/kg/day in 63% of the measurements. The concordance rate did not show the relationship between the Harris-Benedict equation and the values of indirect calorimetry. Stress variables were analyzed, with the SOFA score as the only variable with values close to statistical significance.
In our ICU, the energy needs of critically ill patients in the first week of hospitalization are lower than the intake recommended by the guidelines.
重症患者的营养需求一直是激烈争论的主题。根据国际指南，提倡根据以下建议优化营养摄入量：每天每公斤体重25 - 30千卡。然而，仍有作者建议在住院的第一周允许轻度热量摄入不足。尽管如此，能量消耗（EE）和需求受危重症分解代谢阶段的影响，这在不同患者之间以及同一患者在不同时间可能会有所不同。
本研究的目的是评估入住我们重症监护病房（ICU）的重症患者在住院第一周的能量需求是否符合欧洲临床营养与代谢学会（ESPEN）国际指南的建议。
于2019年9月至12月进行了一项前瞻性横断面研究。通过间接测热法和哈里斯 - 本尼迪克特方程评估能量需求。评估了应激变量，即病理类型、血流动力学支持、镇静、体温、序贯器官衰竭评估（SOFA）评分和出院状态。
本研究纳入了46例患者，间接测热法测得的平均能量消耗为19.22±4.67千卡/千克/天。63%的测量结果显示能量消耗低于20千卡/千克/天。一致性率未显示哈里斯 - 本尼迪克特方程与间接测热法值之间的关系。分析了应激变量，SOFA评分是唯一值接近统计学显著性的变量。
在我们的ICU中，重症患者住院第一周的能量需求低于指南建议的摄入量。
