ESPEN2009 欧洲临床营养指南:重症监护
2010-02-22 16:52:24 来源： 作者： 评论：0 点击：
Indications
Patients should be fed because starvation or underfeeding in ICU patients is associated with increased morbidity and mortality
C
All patients who are not expected to be on normal nutrition within 3 days should receive PN within 24 to 48 h if EN is contraindicated or if they cannot tolerate EN.
C
Requirements
ICU patients receiving PN should receive a complete formulation to cover their needs fully.
C
During acute illness, the aim should be to provide energy as close as possible to the measured energy expenditure in order to decrease negative energy balance.
B
In the absence of indirect calorimetry, ICU patients should receive 25 kcal/kg/day increasing to target over the next 2–3 days.
C
Supplementary PN with EN
All patients receiving less than their targeted enteral feeding after 2 days should be considered for supplementary PN.
C
Carbohydrates
The minimal amount of carbohydrate required is about 2 g/kg of glucose per day. B
Hyperglycemia (glucose >10 mmol/L) contributes to death in the critically ill patient and should also be avoided to prevent infectious complications.
B
Reductions and increases in mortality rates have been reported in ICU patients when blood glucose is maintained between 4.5 and 6.1 mmol/L. No unequivocal recommendation on this is therefore possible at present.
C
There is a higher incidence of severe hypoglycemia in patients treated to the tighter limits. A
Lipids
Lipids should be an integral part of PN for energy and to ensure essential fatty acid provision in long-term ICU patients.
B
Intravenous lipid emulsions (LCT, MCT or mixed emulsions) can be administered safely at a rate of 0.7 g/kg up to 1.5 g/kg over 12 to 24 h
B
The tolerance of mixed LCT/MCT lipid emulsions in standard use is sufficiently documented. Several studies have shown specific clinical advantages over soybean LCT alone but require confirmation by prospective controlled studies.
C
Olive oil-based parenteral nutrition is well tolerated in critically ill patients. B
Addition of EPA and DHA to lipid emulsions has demonstrable effects on cell membranes and inflammatory processes. Fish oil-enriched lipid emulsions probably decrease length of stay in critically ill patients.
B
Amino Acids
When PN is indicated, a balanced amino acid mixture should be infused at approximately 1.3–1.5 g/kg ideal body weight/day in conjunction with an adequate energy supply.
B
When PN is indicated in ICU patients the amino acid solution should contain 0.2–0.4 g/kg/day of L -glutamine (e.g. 0.3–0.6 g/kg/day alanyl-glutamine dipeptide).
A
Micronutrients
All PN prescriptions should include a daily dose of multivitamins and of trace elements. C
Route
A central venous access device is often required to administer the high osmolarity PN mixture designed to cover the nutritional needs fully.
C
Peripheral venous access devices may be considered for low osmolarity (<850 mOsmol/L) mixtures designed to cover a proportion of the nutritional needs and to mitigate negative energy balance.
C
If peripherally administered PN does not allow full provision of the patient’s needs then PN should be centrally administered
C
Mode
PN admixtures should be administered as a complete all-in-one bag
B
Patients should be fed because starvation or underfeeding in ICU patients is associated with increased morbidity and mortality
C
All patients who are not expected to be on normal nutrition within 3 days should receive PN within 24 to 48 h if EN is contraindicated or if they cannot tolerate EN.
C
Requirements
ICU patients receiving PN should receive a complete formulation to cover their needs fully.
C
During acute illness, the aim should be to provide energy as close as possible to the measured energy expenditure in order to decrease negative energy balance.
B
In the absence of indirect calorimetry, ICU patients should receive 25 kcal/kg/day increasing to target over the next 2–3 days.
C
Supplementary PN with EN
All patients receiving less than their targeted enteral feeding after 2 days should be considered for supplementary PN.
C
Carbohydrates
The minimal amount of carbohydrate required is about 2 g/kg of glucose per day. B
Hyperglycemia (glucose >10 mmol/L) contributes to death in the critically ill patient and should also be avoided to prevent infectious complications.
B
Reductions and increases in mortality rates have been reported in ICU patients when blood glucose is maintained between 4.5 and 6.1 mmol/L. No unequivocal recommendation on this is therefore possible at present.
C
There is a higher incidence of severe hypoglycemia in patients treated to the tighter limits. A
Lipids
Lipids should be an integral part of PN for energy and to ensure essential fatty acid provision in long-term ICU patients.
B
Intravenous lipid emulsions (LCT, MCT or mixed emulsions) can be administered safely at a rate of 0.7 g/kg up to 1.5 g/kg over 12 to 24 h
B
The tolerance of mixed LCT/MCT lipid emulsions in standard use is sufficiently documented. Several studies have shown specific clinical advantages over soybean LCT alone but require confirmation by prospective controlled studies.
C
Olive oil-based parenteral nutrition is well tolerated in critically ill patients. B
Addition of EPA and DHA to lipid emulsions has demonstrable effects on cell membranes and inflammatory processes. Fish oil-enriched lipid emulsions probably decrease length of stay in critically ill patients.
B
Amino Acids
When PN is indicated, a balanced amino acid mixture should be infused at approximately 1.3–1.5 g/kg ideal body weight/day in conjunction with an adequate energy supply.
B
When PN is indicated in ICU patients the amino acid solution should contain 0.2–0.4 g/kg/day of L -glutamine (e.g. 0.3–0.6 g/kg/day alanyl-glutamine dipeptide).
A
Micronutrients
All PN prescriptions should include a daily dose of multivitamins and of trace elements. C
Route
A central venous access device is often required to administer the high osmolarity PN mixture designed to cover the nutritional needs fully.
C
Peripheral venous access devices may be considered for low osmolarity (<850 mOsmol/L) mixtures designed to cover a proportion of the nutritional needs and to mitigate negative energy balance.
C
If peripherally administered PN does not allow full provision of the patient’s needs then PN should be centrally administered
C
Mode
PN admixtures should be administered as a complete all-in-one bag
B
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