Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
Faculty of Medicine, University of Southampton, Southampton, UK.
Crit Care. 2024 Feb 1;28(1):38. doi: 10.1186/s13054-024-04803-8.
The optimal feeding strategy for critically ill patients is still debated, but feeding must be adapted to individual patient needs. Critically ill patients are at risk of muscle catabolism, leading to loss of muscle mass and its consequent clinical impacts. Timing of introduction of feeding and protein targets have been explored in recent trials. These suggest that "moderate" protein provision (maximum 1.2 g/kg/day) is best during the initial stages of illness. Unresolved inflammation may be a key factor in driving muscle catabolism. The omega-3 (n-3) fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are substrates for synthesis of mediators termed specialized pro-resolving mediators or SPMs that actively resolve inflammation. There is evidence from other settings that high-dose oral EPA + DHA increases muscle protein synthesis, decreases muscle protein breakdown, and maintains muscle mass. SPMs may be responsible for some of these effects, especially upon muscle protein breakdown. Given these findings, provision of EPA and DHA as part of medical nutritional therapy in critically ill patients at risk of loss of muscle mass seems to be a strategy to prevent the persistence of inflammation and the related anabolic resistance and muscle loss.
对于危重症患者，最佳的喂养策略仍存在争议，但喂养必须根据个体患者的需求进行调整。危重症患者存在肌肉分解代谢的风险，导致肌肉量丢失及其相应的临床影响。最近的试验已经探讨了喂养开始时间和蛋白质目标。这些研究表明，在疾病初始阶段，“适度”蛋白质供给（最高 1.2 g/kg/天）最佳。未解决的炎症可能是驱动肌肉分解代谢的关键因素。ω-3（n-3）脂肪酸二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）是合成被称为专门的促解决介质或 SPM 的介质的底物，这些介质可积极解决炎症。其他情况下有证据表明，高剂量口服 EPA+DHA 可增加肌肉蛋白质合成，减少肌肉蛋白质分解，维持肌肉量。SPM 可能是这些作用的部分原因，尤其是在肌肉蛋白质分解方面。鉴于这些发现，对于有肌肉量丢失风险的危重症患者，将 EPA 和 DHA 作为医学营养治疗的一部分提供，似乎是一种预防炎症持续存在以及相关合成代谢抵抗和肌肉丢失的策略。
