Metabolism and Nutrition in Sepsis: In Need of a Paradigm Shift.
Metabolism and Nutrition in Sepsis: In Need of a Paradigm Shift.
复制标题
脓毒症中的代谢和营养：需要范式转变。
作者：
Collins,Kristina;Huen,SarahC
背景：尽管医疗管理的技术进步，败血症仍然引起显著的发病率和死亡率。虽然败血症被定义为由于宿主对感染反应失调而导致的器官功能障碍，但我们对宿主反应失调的理解仍然不完整。脓毒症期间发生的许多代谢紊乱，包括与厌食症、高血糖和蛋白水解相关的代谢紊乱，在很大程度上被认为是适应性不良。旨在纠正这些代谢紊乱的支持性医疗和营养干预措施并没有导致改善的结果，这表明需要重新评估我们对危重脓毒症患者的代谢和营养方法。这些临床干预措施缺乏疗效的解释可能包括针对错误的指标或患者群体，或者其中一些代谢变化可能具有保护作用。在这篇小型综述中，我们提出了一种范式转变，需要在败血症的代谢和营养管理。
BackgroundSepsis continues to cause significant morbidity and mortality despite technological advancements in medical management. While sepsis is defined as organ dysfunction owing to the dysregulated host response to infection, our understanding of the dysregulation of the host response remains incomplete.SummaryMany metabolic derangements that occur during sepsis, including those associated with anorexia, hyperglycemia, and proteolysis, have largely been considered maladaptive. Supportive medical and nutritional interventions targeted at correcting these metabolic derangements have not led to improved outcomes, suggesting a reappraisal of our approach to metabolism and nutrition in critically ill septic patients is needed.Key MessagesExplanations of the lack of efficacy of these clinical interventions may include targeting the wrong metric or patient population, or the possibility that some of these metabolic changes could be protective. In this mini-review, we propose a paradigm shift that is needed in metabolism and nutrition management in sepsis.