如何避免危害养重症患者:一个基础科学家,营养师和密集医生的观点的综合
Annika Reintam Blaser1,2, Olav Rooyackers3, Danielle E Bear4,5
1Department of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, 50406, Tartu, Estonia. annika.reintam.blaser@ut.ee.
Critical care (London, England)
|July 1, 2023
概括
对于重症患者的最佳营养仍然存在争议. 最近的证据表明,早期全可能是有害的,建议初始能量和蛋白质剂量低,并进行个性化调整.
科学领域:
- 关键护理医学 关键护理医学
- 临床营养学 临床营养学
- 重症监护室的重症监护室的重症监护室.
背景情况:
- 对重症患者的最佳养策略进行了辩论,关于能量和蛋白质目标的指导方针各不相同.
- 最近的临床试验挑战了以前对危急疾病期间营养供应的理解.
研究的目的:
- 从多个专家的角度审查和解释关于重症患者营养的最新证据.
- 为临床实践和重症监护营养领域的未来研究提供联合建议.
主要方法:
- 叙述性综述综合了最近随机对照试验和观察性研究的证据.
- 结合了基础科学家,重症监护营养师和重症监护专家的观点.
主要成果:
- 一项随机对照试验 (RCT) 显示,较低的能量摄入量 (6相对于25千卡/千克/天) 改善了ICU出院准备,并减少了GI并发症.
- 在急性损伤或严重疾病的患者中,高蛋白剂量可能是有害的.
- 在一项观察性研究中,与延迟养相比,早期养,特别是肠道养与28天死亡率更高有关.
结论:
- 危急病患者的早期全可能是有害的.
- 关于危害机制,最佳时间和个性化营养剂量的未解答问题仍然存在.
- 目前的建议包括低初始能量和蛋白质摄入量,其次是基于代谢状态和疾病轨迹的个性化方法.
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