Overcoming challenges to enteral nutrition delivery in critical care.
Overcoming challenges to enteral nutrition delivery in critical care.
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DOI：
10.1097/mcc.0000000000000801
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发表时间：
2021-04-01
影响因子：
3.3
通讯作者：
Wischmeyer PE
中科院分区：
文献类型：
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作者：
Wischmeyer PE
现有数据和所有ICU营养指南强调肠内营养（EN）是一种主要治疗方法，可带来营养和非营养益处。不幸的是，医源性营养不良和喂养不足在ICU入院后的长时间内在全球ICU中几乎普遍存在。克服EN输送的基本挑战需要解决一系列关于EN输送的真实的和经常传播的神话。最近的关键数据解决了EN面临的挑战，包括：接受血管加压剂的成功复苏患者可以并且可能应该接受营养性早期EN，这与最近的死亡率降低有关;使用神经肌肉阻滞剂的瘫痪患者可以并且应该接受早期EN，因为这与最近的死亡率/住院时间降低有关; Proned患者可以安全地接受EN;所有ICU营养输送，包括EN，都应通过间接热量测定（IC）措施进行客观指导。随着新一代IC器件的推出，这一点现在已经成为可能。这是必不可少的实施这一新的证据发生，以克服真实的和感知EN的挑战。这些数据应该导致ICU营养治疗的标准化/协议化，以确保个性化的营养护理在正确的时间为正确的患者提供正确的营养剂量，以优化临床结果。
Existing data and all ICU nutrition guidelines emphasize enteral nutrition (EN) represents a primary therapy leading to both nutritional and non-nutritional benefits. Unfortunately, iatrogenic malnutrition and underfeeding is virtually ubiquitous in ICUs worldwide for prolonged periods post-ICU admission. Overcoming essential challenges to EN delivery requires addressing a range of real, and frequently propagated myths regarding EN delivery. Key recent data addresses perceived challenges to EN including: Adequately resuscitated patients on vasopressors can and likely should receive trophic early EN and this was recently associated with reduced mortality; Patients paralyzed with neuromuscular blocking agents can and should receive early EN as this was recently associated with reduced mortality/hospital length of stay; Proned patients can safely receive EN; All ICU nutrition delivery, including EN, should be objectively guided by indirect calorimetry (IC) measures. This is now possible with the new availability of a next-generation IC device. It is the essential implementation of this new evidence occurs to overcome real and perceived EN challenges. This data should lead to increased standardization/protocolization of ICU nutrition therapy to ensure personalized nutrition care delivering the right nutrition dose, in the right patient, at the right time to optimize clinical outcome.