败血性休克中的肠道营养:呼吁改变范式
Jayshil J Patel1, Juan Carlos Lopez-Delgado2, Christian Stoppe3,4
1Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Current opinion in critical care
|March 5, 2024
概括
在败血症休克中早期的肠道营养可能会导致并发症. 最近的试验表明,较低剂量策略更安全,平衡肠道健康益处与肠道缺血等风险,特别是高压缩剂使用.
科学领域:
- 关键护理医学 关键护理医学
- 胃肠病学 胃肠病学
- 营养支持营养支持
背景情况:
- 肠道营养 (EN) 对于关键疾病中的肠道屏障功能至关重要.
- 由于潜在的肠道低 perfusion 和食不耐受性,败血性休克是一个挑战.
- 与肠道缺血等风险平衡EN的好处是必不可少的.
研究的目的:
- 评估当代关于EN在败血症休克中的证据.
- 确定肠道食不耐受症 (EFI) 的危险因素.
- 评估EFI的定义,并探索EN指导的临床监测.
主要方法:
- 对当代证据和随机对照试验 (RCT) 的审查.
- 对NUTRIREA-2和NUTRIREA-3试验数据的分析.
- 对感染性休克患者内结局影响因素的评估.
主要成果:
- 在NUTRIREA试验中,感染性休克患者早期标准剂量EN导致胃肠道并发症增加和肠道缺血.
- 较高的疾病严重程度和血管压缩剂剂量与不良结果相关.
- 支持在早期严重疾病中对EN剂量的"少是多"方法.
结论:
- 早期EN的好处必须与风险进行权衡,特别是肠道缺血.
- EN剂量,血管压缩剂负荷和疾病严重程度是感染性休克的关键因素.
- 对床边工具进行进一步的研究是必要的,以指导EN启动和发展.
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