Chronic Critical Illness and PICS Nutritional Strategies.
Chronic Critical Illness and PICS Nutritional Strategies.
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DOI：
10.3390/jcm10112294
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发表时间：
2021-05-25
影响因子：
3.9
通讯作者：
Moore FA
中科院分区：
文献类型：
--
作者：
Rosenthal MD;Vanzant EL;Moore FA
脓毒症后慢性危重症（CCI）的营养标志是持续炎症、免疫抑制和分解代谢综合征（PICS），这导致对营养补充剂合成代谢作用的全面抵抗。这最终使这些患者处于一种向下的表型螺旋，其特征是恶病质严重虚弱，康复能力下降，免疫抑制并倾向于败血症再犯。持续的分解代谢是由无法恢复体内平衡的病理性低度炎症和持续增加的能量消耗驱动的。更好的重症监护支持系统和技术进步导致重症监护病房（ICU）生存率增加，但由于长期预后不良的PICS引起的CCI已成为ICU败血症幸存者中常见的表型。不幸的是，缓解或逆转PICS-CCI的治疗方法有限，最近的证据表明，这些患者对ICU早期循证营养方案没有反应。缺乏随机对照试验限制了对这些患者进行营养辅助治疗的强烈建议。然而，基于以类似表型为特征的其他疾病的经验，旨在对抗炎症、免疫抑制和分解代谢的免疫营养素可能对改善PICS-CCI患者的预后很重要。本文旨在回顾几种免疫营养素作为治疗PICS-CCI的辅助疗法。
The nutritional hallmark of chronic critical illness (CCI) after sepsis is persistent inflammation, immunosuppression, and catabolism syndrome (PICS), which results in global resistance to the anabolic effect of nutritional supplements. This ultimately leaves these patients in a downward phenotypic spiral characterized by cachexia with profound weakness, decreased capacity for rehabilitation, and immunosuppression with the propensity for sepsis recidivism. The persistent catabolism is driven by a pathologic low-grade inflammation with the inability to return to homeostasis and by ongoing increased energy expenditure. Better critical care support systems and advances in technology have led to increased intensive care unit (ICU) survival, but CCI due to PICS with poor long-term outcomes has emerged as a frequent phenotype among ICU sepsis survivors. Unfortunately, therapies to mitigate or reverse PICS-CCI are limited, and recent evidence supports that these patients fail to respond to early ICU evidence-based nutrition protocols. A lack of randomized controlled trials has limited strong recommendations for nutrition adjuncts in these patients. However, based on experience in other conditions characterized by a similar phenotype, immunonutrients aimed at counteracting inflammation, immunosuppression, and catabolism may be important for improving outcomes in PICS-CCI patients. This manuscript intends to review several immunonutrients as adjunctive therapies in treating PICS-CCI.
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DOI：
10.1097/00075197-200503000-00016
发表时间：
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影响因子：
3.1
作者：
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影响因子：
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