Abdelrahim Rana A, Mekala Sai Rohit R, Polepalli Krishna V, Priyatha Vemparala, Ezeano Chimezirim, AlEdani Esraa M, Nassar Sondos T
Medicine, The Royal College of Surgeons in Ireland-Bahrain, Busaiteen, BHR.
Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Cureus. 2024 Jul 26;16(7):e65455. doi: 10.7759/cureus.65455. eCollection 2024 Jul.
Critical illness encompasses the dysfunction of vital organs, the risk of death, and potential reversibility; it is a major cause of morbidity and mortality globally. The pathophysiology underlying many critical illnesses includes bioenergetic failure, inflammation, and oxidative stress. This systematic review aims to explore the use of nutritional ketosis (ketogenic feeds and exogenous ketone body administration) as a potential therapy, affecting the aforementioned pathways in patients with critical illnesses. This study was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The search was conducted, systematically using PubMed, PubMed Central (PMC), Google Scholar, and the ScienceDirect databases in February 2024. The inclusion criteria were set to free full-text articles published within the past five years: human and animal studies, literature reviews, systematic reviews, meta-analyses, observational studies, randomized controlled trials, case reports, book chapters, gray literature, studies investigating adult samples, and articles in the English language. Exclusion criteria included pediatric studies as the topic has been studied more extensively in children, and this review aims to explore potential benefits in adult patients. The search was conducted through four databases; after the screening process, the remaining studies were assessed through quality appraisal tools appropriate to each study type. In the end, 11 studies were selected, including eight narrative reviews, one cohort study, one animal study, and one randomized controlled trial. The results of this review demonstrated that nutritional ketosis has potential safe and effective benefits for humans and animals. Nutritional ketosis shows therapeutic benefits for a vast variety of complications commonly associated with critical illness, status epilepticus, sepsis, viral infections, and glycemic control. In the end, both randomized and nonrandomized clinical trials are necessary for more conclusive findings.
危重病包括重要器官功能障碍、死亡风险和潜在可逆性；它是全球发病和死亡的主要原因。许多危重病的病理生理学包括生物能量衰竭、炎症和氧化应激。本系统评价旨在探讨营养性酮症（生酮饮食和外源性酮体给药）作为一种潜在治疗方法，对危重病患者上述病理生理途径的影响。本研究按照系统评价和Meta分析的首选报告项目（PRISMA）2020指南进行。2024年2月，系统地使用PubMed、PubMed Central（PMC）、谷歌学术和ScienceDirect数据库进行检索。纳入标准设定为过去五年内发表的免费全文文章：人类和动物研究、文献综述、系统评价、Meta分析、观察性研究、随机对照试验、病例报告、书籍章节、灰色文献、研究成人样本的研究以及英文文章。排除标准包括儿科研究，因为该主题在儿童中已有更广泛的研究，而本综述旨在探讨对成年患者的潜在益处。通过四个数据库进行检索；在筛选过程之后，使用适合每种研究类型的质量评估工具对剩余研究进行评估。最终，选择了11项研究，包括8篇叙述性综述、1项队列研究、1项动物研究和1项随机对照试验。本综述结果表明，营养性酮症对人类和动物具有潜在的安全有效益处。营养性酮症对与危重病、癫痫持续状态、脓毒症、病毒感染和血糖控制常见相关的多种并发症显示出治疗益处。最后，需要随机和非随机临床试验来获得更确凿的结果。
