Rosseel Zenzi, Cortoos Pieter-Jan, Leemans Lynn, van Zanten Arthur R H, Ligneel Claudine, De Waele Elisabeth
Department of Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium.
Department of Clinical Nutrition, Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium.
JPEN J Parenter Enteral Nutr. 2025 Jan;49(1):18-32. doi: 10.1002/jpen.2699. Epub 2024 Nov 6.
Adequate energy and protein provision is mandatory to optimize survival chances in critical illness, prevent loss of muscle mass, and reduce length of stay. Data are available concerning feeding adequacy in intensive care unit (ICU) participants, but little is known about the adequacy in post-ICU participants. This systematic review aimed to evaluate feeding adequacy in post-ICU participants and addressed causes of feeding interruption leading to suboptimal adequacy.
For this systematic review, a bibliographic search was performed in PubMed, Scopus, and Web of Science. Randomized controlled studies, non-randomized controlled studies, and observational studies conducted between January 1990 and November 2023 fulfilling the inclusion criteria were withheld.
Eight studies were included. Outcomes reported were energy and protein adequacy, barriers, and feeding routes. Energy and protein requirements were determined in various ways, including indirect calorimetry and standardized and weight-based formulas. Energy adequacy ranged from 52% to 102% and protein adequacy between 63% and 86%. Participants were mainly fed with enteral nutrition (EN) or a combination of oral nutrition and EN. The main barrier reported for inadequate nutrition intake was feeding tube removal.
Next to different ways in calculating targets and reporting results, a wide range in energy and protein adequacy was observed, but with constant protein underfeeding. Participants fed with EN or a combination of EN and oral nutrition had the best adequacy; inappropriate tube removal is a common barrier leading to inadequate therapy. Standardized reporting and larger studies are needed to guide nutrition care for post-ICU participants.
提供充足的能量和蛋白质对于优化危重症患者的生存几率、防止肌肉量流失以及缩短住院时间至关重要。关于重症监护病房（ICU）患者的喂养充足情况已有相关数据，但对于ICU后患者的喂养充足情况知之甚少。本系统评价旨在评估ICU后患者的喂养充足情况，并探讨导致喂养不足的喂养中断原因。
对于本系统评价，在PubMed、Scopus和Web of Science中进行了文献检索。纳入了1990年1月至2023年11月期间进行的符合纳入标准的随机对照研究、非随机对照研究和观察性研究。
纳入了八项研究。报告的结果包括能量和蛋白质充足情况、障碍因素及喂养途径。能量和蛋白质需求通过多种方式确定，包括间接测热法以及标准化公式和基于体重的公式。能量充足率在52%至102%之间，蛋白质充足率在63%至86%之间。参与者主要接受肠内营养（EN）或口服营养与EN的联合喂养。报告的营养摄入不足的主要障碍是喂养管拔除。
除了计算目标和报告结果的方式不同外，观察到能量和蛋白质充足率范围较广，但蛋白质持续摄入不足。接受EN或EN与口服营养联合喂养的参与者充足率最佳；不当的喂养管拔除是导致治疗不足的常见障碍。需要标准化报告和更大规模的研究来指导ICU后患者的营养护理。
