Early and Adequate Protein Feeding Post-Traumatic Injury

项目摘要 建立创伤后早期营养支持是ICU的护理标准。那里 有充分的证据表明，早期肠内营养（伤后24-48小时内）与 积极的结果，但关于最佳营养量的争议仍然存在 在受伤后的第一周。避免过度喂养，以防止高血糖和液体 热量目标为能量需求的60-80%的超负荷可以证明是最佳的，只要 蛋白质的供应量至少为1.5克/千克/天。我们的计划是在一个盲态的 波士顿医疗中心外科重症监护室收治的时尚患者， 接受外周输注的氨基酸溶液，以提供至少1.5克pro/kg 在损伤后24小时内，或安慰剂，其以相似的速率输注D10 W 5天。这些 输注将补充规定的正常肠内喂养，并在耐受范围内提前， 两组患者。将在基线时进行测量，并在第4-5天再次进行测量， 炎症的血浆标志物（细胞因子）和代谢组学特征。24小时尿液 在两组中的第1天和第5天采集样本以确定氮平衡， 分解代谢指数五天后，输液将停止，患者将继续他们的治疗。 肠内喂养耐受。每日营养摄入量、感染率和 将记录器官功能障碍。每天测量APACHE II、SIRS和SOFA评分 前5天，然后每3天一次，直至第28天出院或死亡。调查人员 将使用以下方法跟踪住院期间感染（血液、尿液、伤口、肺部）的发生率 发表的定义来自重症监护医学。我们的主要成果是看到 蛋白质输注组的代谢组学特征支持改善蛋白质经济性， 可能更少的脂肪酸移动。我们还预计， 氨基酸注入和改善氮平衡。

Project Summary Establishing early nutrition support post traumatic injury is the standard of care in ICU's. There is ample evidence that early enteral nutrition (within 24-48 hours post injury) is associated with positive outcomes, but controversy persists regarding the optimal amount of nutrition to be fed in the first week post injury. The avoidance of overfeeding to prevent hyperglycemia and fluid overload with a caloric goal of 60-80% of energy requirements may prove optimal as long as there is a supply of protein of at least 1.5 grams/kg /day. Our plan is to randomize in a blinded fashion patients admitted to the Surgical Intensive Care Unit at Boston Medical Center to either receive a peripherally infused amino acid solution to provide at least 1.5 grams pro/kg from within 24 hours of injury or placebo, which is D10W infused at a similar rate for 5 days. These infusions will supplement the normal enteral feedings prescribed and advanced as tolerated for patients in both groups. Measurements will be taken at baseline and again on day 4-5 for plasma markers of inflammation (cytokines) and a metabolomics profile. A 24 hour urine collection will be obtained on day 1 and day 5 in both groups to determine nitrogen balance and Catabolic Index. After five days, infusions will be stopped and patients will continue on their enteral feedings as tolerated. Estimates of daily nutrition intake, incidence of infection and organ dysfunction will be recorded. APACHE II, SIRS and SOFA scores will be measured daily for the first 5 days and then every three days until day 28, discharge or death. The investigators will track the incidence of infections (blood, urine, wound, lung) during their hospitalization using published definitions from Critical Care Medicine. Our primary outcome is to see a difference in the metabolomics profile in the protein infusion group supporting improved protein economy and possibly less fatty acid mobilization. We also anticipate less of an inflammatory response with the amino acid infusion and improved nitrogen balance.