Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
Nutrition. 2024 Jan;117:112255. doi: 10.1016/j.nut.2023.112255. Epub 2023 Oct 5.
Acute gastrointestinal injury (AGI) is very common in critically ill patients, and its severity is positively correlated with mortality. Critically ill patients with digestive and absorption dysfunction caused by AGI face higher nutritional risks, making nutritional support particularly important. Early enteral nutrition (EN) support is extremely important because it can promote the recovery of intestinal function, protect the intestinal mucosal barrier, reduce microbiota translocation, reduce postoperative complications, shorten hospital stay, and improve clinical prognosis. In recent years, many nutritional guidelines have been proposed for critically ill patients; however, there are few recommendations for the implementation of EN in patients with AGI, and their quality of evidence is low. The use of EN feeding strategies in critically ill patients with AGI remains controversial. The aim of this review was to elaborate on how EN feeding strategies should transition from limited to progressive to open feeding and explain the time window for this transition.
急性胃肠损伤(AGI)在危重症患者中非常常见,其严重程度与死亡率呈正相关。由于 AGI 导致消化吸收功能障碍的危重症患者面临更高的营养风险,因此营养支持尤为重要。早期肠内营养(EN)支持非常重要,因为它可以促进肠道功能恢复,保护肠黏膜屏障,减少菌群易位,降低术后并发症发生率,缩短住院时间,改善临床预后。近年来,针对危重症患者提出了许多营养指南;然而,对于 AGI 患者实施 EN 的建议很少,其证据质量也较低。在 AGI 危重症患者中使用 EN 喂养策略仍存在争议。本综述的目的是详细阐述 EN 喂养策略应如何从限制喂养过渡到逐渐开放喂养,并解释这种过渡的时间窗口。