F1. Based on expert consensus, we suggest that a fermentable soluble fiber (e.g., fructo-oligossaccharides [FOSs], inulin) additive be considered for routine use in all hemodynamically stable medical and surgical ICU patients placed on a standard enteral formulation. We suggest that 10–20 grams of a fermentable soluble fiber supplement be given in divided doses over 24 hours as adjunctive therapy if there is evidence of diarrhea.
根據(jù)專家共識(shí)，建議血流動(dòng)力學(xué)穩(wěn)定的內(nèi)科與外科ICU患者，可考慮添加發(fā)酵性可溶性纖維（如低聚果糖[FOSs], 菊粉）。合并腹瀉患者推薦添加10-20g可溶性纖維，于24小時(shí)內(nèi)分次給予。
F2. We suggest that, while the use of studied probiotics species and strains appear to be safe in general ICU patients, they should be used only for select medical and surgical patient populations for which RCTs have documented safety and outcome benefit. We cannot make a recommendation at this time for the routine use of probiotics across the general population of ICU patients.
[Quality of Evidence: Low]
雖然研究所用的益生菌類別與菌種在綜合ICU患者顯示是安全的，但也僅限用于那些RCT研究證實(shí)安全且有益預(yù)后的內(nèi)外科患者，目前尚不能推薦此范圍以外ICU患者常規(guī)使用益生菌制劑。
[證據(jù)質(zhì)量：低]
F3. We suggest that a combination of antioxidant vitamins and trace minerals in doses reported to be safe in critically ill patients be provided to those patients who require specialized nutrition therapy
[Quality of Evidence: Low]
對(duì)于需要特殊營養(yǎng)治療的重癥患者，我們建議依據(jù)報(bào)道的安全劑量補(bǔ)充抗氧化維生素與微量元素。
[證據(jù)質(zhì)量：低]
F4. We suggest that supplemental enteral glutamine NOT be added to an en regimen routinely in critically ill patients.
[Quality of Evidence: Moderate]
我們建議腸內(nèi)補(bǔ)充谷氨酰胺不應(yīng)納入危重癥患者EN的常規(guī)處方中。
[證據(jù)質(zhì)量：中]
G1. We suggest that, in the patient at low nutrition risk (for example, NRS-2002 ≤ 3 or NUTRIC score ≤ 5), exclusive PN be withheld over the first 7 days following ICU admission if the patient cannot maintain volitional intake and if early EN is not feasible.
[Quality of Evidence: Very Low]
我們建議，對(duì)于低營養(yǎng)風(fēng)險(xiǎn)（如：NRS-2002≤3或NUTRIC評(píng)分≤5）、不適宜早期腸內(nèi)營養(yǎng)、且入ICU 7天仍不能保證經(jīng)口攝食量的患者，7天后給予PN支持。
G2. Based on expert consensus, in the patient determined to be at high nutrition risk (for example, NRS-2002 ≥ 5 or NUTRIC score ≥ 6) or severely malnourished, when en is not feasible, we suggest initiating exclusive PN as soon as possible following ICU admission.
根據(jù)專家共識(shí)，確定存在高營養(yǎng)風(fēng)險(xiǎn)（如：NRS-2002≥5或NUTRIC評(píng)分 ≥6）或嚴(yán)重營養(yǎng)不良的患者，如果EN不可行，我們建議入ICU后盡早開始PN。
G3. We recommend that, in patients at either low or high nutrition risk, use of supplemental PN be considered after 7 to 10 days if unable to meet > 60% of energy and protein requirements by the enteral route alone. Initiating supplemental PN prior to this 7–10-day period in critically ill patients on some en does not improve outcomes and may be detrimental to the patient.
[Quality of Evidence: Moderate]
無論低或高營養(yǎng)風(fēng)險(xiǎn)患者，接受腸內(nèi)營養(yǎng)7-10天，如果經(jīng)EN攝入能量與蛋白質(zhì)量仍不足目標(biāo)的60%，我們推薦應(yīng)考慮給予補(bǔ)充型PN。在開始EN7天內(nèi)給予補(bǔ)充型PN，不僅不能改善預(yù)后，甚至可能有害。
[證據(jù)質(zhì)量：中]
H1. Based on expert consensus, we suggest the use of protocols and nutrition support teams to help incorporate strategies to maximize efficacy and reduce associated risk of PN.
根據(jù)專家共識(shí)，我們建議使用營養(yǎng)支持實(shí)施方案與營養(yǎng)支持小組，以促進(jìn)營養(yǎng)支持策略的最大化獲益并降低PN相關(guān)風(fēng)險(xiǎn)。
H2. We suggest that hypocaloric PN dosing (≤ 20 kcal/kg/day or 80% of estimated energy needs) with adequate protein (≥ 1.2g protein/kg/day) be considered in appropriate patients (high risk or severely malnourished) requiring PN, initially over the first week of hospitalization in the ICU.
[Quality of Evidence: Low]
對(duì)于高營養(yǎng)風(fēng)險(xiǎn)或嚴(yán)重營養(yǎng)不良、需要PN支持的患者，我們建議住ICU第一周內(nèi)給予低熱卡PN（≤20 kcal/kg/day 或能量需要目標(biāo)的80%），以及充分的蛋白質(zhì)補(bǔ)充（≥ 1.2 g/kg/day）。
[證據(jù)質(zhì)量：低]
H3a. We suggest withholding or limiting SO-based IVFE during the first week following initiation of PN in the critically ill patient to a maximum of 100 g/week (often divided into 2 doses/week) if there is concern for essential fatty acid deficiency.
[Quality of Evidence: Very Low]
危重病患者開始PN的第一周，我們建議暫緩或限制大豆油基礎(chǔ)的靜脈脂肪乳劑輸注，如果考慮必需脂肪酸缺乏，其最大補(bǔ)充劑量為100g／每周（常分2次補(bǔ)充）。
[證據(jù)質(zhì)量：非常低]
H3b. Alternative IVFE may provide outcome benefit over soy-based IVFE; however, we cannot make a recommendation at this time due to lack of availability of these products in the U.S. When these alternative IVFEs (SMOF, MCT, OO and FO) become available in the United States, based on expert opinion, we suggest that their use be considered in the critically ill patient who is an appropriate candidate for PN.
新一代的IVFE比大豆油基礎(chǔ)的IVFE對(duì)預(yù)后具有更好影響；但是，鑒于美國這類產(chǎn)品的缺乏，故尚不能做出任何推薦意見。根據(jù)專家意見，一旦這類脂肪乳劑（SMOF, MCT, OO, FO）在美國上市，建議在有PN適應(yīng)癥的重癥患者使用。
H4. Based on expert consensus, use of standardized commercially available PN versus compounded PN admixtures in the ICU patient has no advantage in terms of clinical outcomes.
根據(jù)專家共識(shí)，標(biāo)準(zhǔn)商品化的PN制劑（多腔袋）與配置PN液相比，未見任何影響ICU患者臨床結(jié)局的優(yōu)勢(shì)。
H5. We recommend a target blood glucose range of 140– or 150–180 mg/dl for the general ICU population; ranges for specific patient populations (post-cardiovascular surgery, head trauma) may differ and are beyond the scope of this guideline.
[Quality of Evidence: Moderate]
我們推薦綜合ICU患者的血糖控制目標(biāo)在：140–180 或 150–180 mg/dl；特殊患者（心血管術(shù)后，顱腦損傷）可能有超出指南的不同推薦。
[證據(jù)質(zhì)量：中]
H6. We recommend that parenteral glutamine supplementation NOT be used routinely in the critical care setting.
[Quality of Evidence: Moderate]
我們推薦危重病患者腸外營養(yǎng)期間無需常規(guī)補(bǔ)充谷氨酰胺。
[證據(jù)質(zhì)量：中]
H7. Based on expert consensus, we suggest that, as tolerance to EN improves, the amount of PN energy should be reduced and finally discontinued when the patient is receiving > 60% of target energy requirements from EN.
根據(jù)專家共識(shí)，當(dāng)EN耐受性提高，達(dá)到目標(biāo)能量60%以上時(shí)，我們建議經(jīng)PN途徑供給的能量可逐漸減量至終止。
聯(lián)系客服
