2016重症营养6.doc

SCCM/ASPEN成年危重病患者营养支持治疗实施与评估指南(6/6) 2016年03月02日??? HYPERLINK /?cat=25 指南导读,? HYPERLINK /?cat=23 进展交流??? HYPERLINK /?p=8737 \l respond 暂无评论 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) 成年危重病患者营养支持治疗的实施与评估指南：美国危重病医学会(SCCM)与美国肠外肠内营养学会(ASPEN) Taylor BE, McClave SA, Martindale RG, et al. Crit Care Med 2016; 44: 390-438 翻译：清华大学长庚医院 周华 许媛 P. CHRONICALLY CRITICALLY ILL?慢性危重病患者 Question:?How should the chronically critically ill patient be managed with nutrition therapy? 问题：如何管理慢性危重病患者的营养治疗？ P1. Based on expert consensus, we suggest that chronically critically ill patients (defined as those with persistent organ dysfunction requiring ICU LOS 21 days) be managed with aggressive high-protein EN therapy and, when feasible, that a resistance exercise program be used. 根据专家共识，我们建议慢性危重病患者（定义为那些因持续存在器官功能不全需要住ICU 21天的患者）给予积极高蛋白质EN治疗，且如有可能，应制订抗阻力功能锻炼计划。 ? O. OBESITY IN CRITICAL ILLNESS?肥胖患者的危重病 Question:?Do obese ICU patients benefit less from early EN in the first week of hospitalization, due to their nutrition reserves, than their lean counterparts? 问题：肥胖的ICU患者因具有营养储备，是否比消瘦患者从住院第一周的早期EN中获益更少？ Q1. Based on expert consensus, we suggest that early EN start within 24–48 hours of admission to the ICU for obese patients who cannot sustain volitional intake. 根据专家共识，肥胖患者不能经口摄食时，我们建议在收入ICU 24-48小时内即开始早期EN。 ? Question:?What additional parameters should be addressed with a nutrition assessment in critical illness when the patient is obese? 问题：对肥胖的危重病患者进行营养评估时，需要额外考虑哪些指标？ Q2. Based on expert consensus, we suggest that nutrition assessment of the obese ICU patient focus on biomarkers of metabolic syndrome, an evaluation of comorbidities, and a determination of level of inflammation, in addition to those parameters described for all ICU patients. 根据专家共识，建议对ICU肥胖患者进行营养评估时，除所有ICU患者的常规指标外，我们建议重视代谢综合征的生物标志物，评价合并症，并确