Reignier Jean, Rice Todd W, Arabi Yaseen M, Casaer Michael
Nantes University, CHU Nantes, Movement - Interactions - Performance (MIP), UR 4334; and Nantes University Hospital, Medical Intensive Care Unit; Nantes, France
Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
BMJ. 2025 Jan 2;388:e077979. doi: 10.1136/bmj-2023-077979.
Critical illness is a complex condition that can have a devastating impact on health and quality of life. Nutritional support is a crucial component of critical care that aims to maintain or restore nutritional status and muscle function. A one-size-fits-all approach to the components of nutritional support has not proven beneficial. Recent randomized controlled trials challenge the conventional strategy and support the safety and potential benefits of below-usual calorie and protein intakes at the early, acute phase of critical illness. Further research is needed to define optimal nutritional support throughout the intensive care unit stay. Individualized nutritional strategies relying on risk assessment tools or biomarkers deserve further investigation in rigorously designed, large, multicenter, randomized, controlled trials. Importantly, although nutritional support is crucial, it might not be sufficient to enhance the recovery of critically ill patients. Thus, achieving the greatest efficacy may require individualized nutritional support combined with early, prolonged physical rehabilitation within a multimodal, holistic care program throughout the patient's recovery journey.
危重病是一种复杂的病症，会对健康和生活质量产生毁灭性影响。营养支持是重症监护的关键组成部分，旨在维持或恢复营养状况和肌肉功能。采用一刀切的方法来进行营养支持的各个组成部分并未被证明是有益的。最近的随机对照试验对传统策略提出了挑战，并支持在危重病的早期急性期采用低于通常热量和蛋白质摄入量的安全性及潜在益处。需要进一步研究以确定在整个重症监护病房住院期间的最佳营养支持方案。依靠风险评估工具或生物标志物的个体化营养策略值得在设计严谨、大规模、多中心、随机对照试验中进行进一步研究。重要的是，尽管营养支持至关重要，但可能不足以促进危重病患者的康复。因此，要实现最大疗效可能需要个体化营养支持，并在患者整个康复过程的多模式整体护理计划中结合早期、长期的身体康复。
