Fishman Guy, Singer Pierre
Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, The Sackler School of Medicine, Tel Aviv University, Petach Tikva 49100, Israel.
J Intensive Med. 2023 Jan 30;3(3):228-238. doi: 10.1016/j.jointm.2022.11.001. eCollection 2023 Jul 31.
Nutrition is one of the foundations for supporting and treating critically ill patients. Nutritional support provides calories, protein, electrolytes, vitamins, and trace elements via the enteral or parenteral route. Acute kidney injury (AKI) is a common and devastating problem in critically ill patients and has significant metabolic and nutritional consequences. Moreover, renal replacement therapy (RRT), whatever the modality used, also profoundly impacts metabolism. RRT and of the extracorporeal circuit impede 'effect the evaluation of a patient's energy requirements by clinicians. Substrates added and removed within the extracorporeal treatment are not always taken into consideration, making treatment even more challenging. Furthermore, evidence on nutritional support during continuous renal replacement therapy (CRRT) is scarce, and there are no clinical guidelines for nutrition adaptations during CRRT in critically ill patients. Most recommendations are based on expert opinions. This review discusses the complex interaction between nutritional support and CRRT and presents some milestones for nutritional support in critically ill patients on CRRT.
营养是支持和治疗重症患者的基础之一。营养支持通过肠内或肠外途径提供热量、蛋白质、电解质、维生素和微量元素。急性肾损伤（AKI）在重症患者中是一个常见且严重的问题，会产生重大的代谢和营养后果。此外，无论采用何种方式，肾脏替代治疗（RRT）也会对代谢产生深远影响。RRT及体外循环会妨碍临床医生对患者能量需求的评估。体外治疗过程中添加和去除的底物往往未被考虑在内，这使得治疗更具挑战性。此外，关于持续肾脏替代治疗（CRRT）期间营养支持的证据很少，对于重症患者CRRT期间的营养调整也没有临床指南。大多数建议基于专家意见。本综述讨论了营养支持与CRRT之间的复杂相互作用，并提出了重症患者CRRT营养支持的一些关键要点。
