When a calorie isn't just a calorie: a revised look at nutrition in critically ill patients with sepsis and acute kidney injury.
When a calorie isn't just a calorie: a revised look at nutrition in critically ill patients with sepsis and acute kidney injury.
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当卡路里不只是卡路里时：重新审视脓毒症和急性肾损伤重症患者的营养问题
DOI：
10.1097/mnh.0000000000000801
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发表时间：
2022-07-01
影响因子：
3.2
通讯作者：
Huen, Sarah C.
中科院分区：
文献类型：
--
作者：
Nadamuni, Mridula;Venable, Andrea H.;Huen, Sarah C.
探讨如何优化营养管理以促进脓毒症及相关急性肾损伤的保护性代谢。最近的证据表明，脓毒症是一种代谢上不同的危重疾病，某些代谢改变，如空腹代谢的激活，可能对细菌性脓毒症有保护作用。这些发现可能解释了最近的随机对照试验中营养治疗对危重病缺乏生存益处。这些试验受到队列异质性的限制，结合了脓毒性和非脓毒性危重病，以及使用不准确的热量估计来确定能量需求。这些能量估计也不能提供关于特定底物偏好或底物利用能力的信息。因此，超过蛋白质合成能力的高蛋白喂养可能会对脓毒症患者造成伤害。过量的葡萄糖和胰岛素暴露抑制脂肪酸氧化、酮生成和自噬，其中新出现的证据表明其对脓毒症相关的器官损伤如急性肾损伤具有保护作用。区分致病性和保护性脓毒症相关的代谢变化是至关重要的，以加强和个性化的营养管理危重病人。
To discuss how nutritional management could be optimized to promote protective metabolism in sepsis and associated acute kidney injury. Recent evidence suggests that sepsis is a metabolically distinct critical illness and that certain metabolic alterations, such as activation of fasting metabolism, may be protective in bacterial sepsis. These findings may explain the lack of survival benefit in recent randomized controlled trials of nutrition therapy for critical illness. These trials are limited by cohort heterogeneity, combining both septic and non-septic critical illness, and the use of inaccurate caloric estimates to determine energy requirements. These energy estimates are also unable to provide information on specific substrate preferences or the capacity for substrate utilization. As a result, high protein feeding beyond the capacity for protein synthesis could cause harm in septic patients. Excess glucose and insulin exposures suppress fatty acid oxidation, ketogenesis and autophagy, of which emerging evidence suggest are protective against sepsis associated organ damage such as acute kidney injury. Distinguishing pathogenic and protective sepsis-related metabolic changes are critical to enhancing and individualizing nutrition management for critically ill patients.