Nutrition in the Acute Phase of Critical Illness% P5 M! E9 B+ d6 @! m6 Y$ G, I O
危重患者急性期的营养5 g+ E$ L }, P
, H; r& }' u& ^1 [" KMichael P. Casaer, M.D., Ph.D., and Greet Van den Berghe, M.D., Ph.D.* l" K f s" V/ P
& e3 Z' r J8 C N. i- C
Critically ill patients requiring vital organ support in the intensive care unit (ICU) commonly have anorexia and may be unable to feed volitionally by mouth for periods ranging from days to months. Unless such patients are provided with macronutrients in the form of enteral or parenteral nutrition, they accumulate an energy deficit that rapidly reaches proportions that contribute to lean-tissue wasting and that are associated with adverse outcomes. The catabolic response to acute critical illness is much more pronounced than that evoked by fasting in healthy persons, since the energy deficit in acutely ill patients is often superimposed on immobilization and pronounced inflammatory and endocrine stress responses. Severe skeletal-muscle wasting and weakness occurring during critical illness are associated with a prolonged need for mechanical ventilation and rehabilitation.: s% a2 x. i- a. }( N
. ~! S# A0 [; ^! s2 c7 }5 G
In many studies, the degree of energy deficit accumulating in critically ill patients is strongly associated with the duration of stay in the ICU, which, in turn, is associated with an increased incidence of infectious complications and risk of death.1 Until recently, however, the causality of these associations remained unclear, since the majority of studies that formed the basis of published recommendations for feeding ICU patients were either observational or small interventional studies. Recently, the field of critical care nutrition has been revived by the findings of several randomized, controlled trials, which have opened a new debate on nutritional practice in the ICU. $ H* Y) z2 W- W8 Q3 j5 q
; n3 m6 O, [1 N/ W! P! L- D3 U" MFor this review, we focus on evidence from randomized, controlled studies that met the following criteria: study-group assignments were made in a blinded fashion, the sample size was sufficiently large to detect a prespecified treatment effect, there was a clear delineation of the way in which patients were selected and followed, there was a statistical analysis plan with end points defined a priori, and there was an intention-to-treat analysis with adequate handling of competing risks (Table 1). In this review, we integrate this newer evidence with older high-level evidence to provide suggestions for feeding during the acute phase of critical illness. In cases in which such evidence does not exist, we identify areas of uncertainty that require further investigation.+ Y9 Z y( x1 h0 K. R- ^4 a
* G! u, L: s7 m3 |; b. z- `8 ^
危重患者急性期的营养.pdf
(534.86 KB, 下载次数: 288)
|
公益再升级！低至2000+的肿瘤基因检
作者：pears
近年来，随着医疗水平的进步，癌症也在逐渐进入慢病化管理，而靶向药物的
晚期肺癌经过4次换药，如今母亲已经4
作者：pears
“万事开头难”这句话在母亲的抗癌路上体现得淋漓尽致，最初确诊肺癌后半
父亲的治疗传来了好消息
父亲今年68岁，从今年三月低确认肺癌晚期到现在，一直没有好消息。胸水基因检测：EGFR
父亲肺鳞T2N3M0
现在二次化疗结束用药奈达铂+白紫+卡瑞丽珠单抗
咨询后续如何治疗，是二化结束后放疗
神奇的ommaya囊——学习笔记
一个神奇的装置-ommaya囊——————9.28 苗茜医生科普讲座
直播链接：https://live.
显身卡
