中毒急危重患者的營養(yǎng)支持(參考版)
2024-10-06 03:16本頁面
【正文】 尿氮與氮平衡 第五十八頁，共五十八頁。如果殘留量 ≥200ml，應(yīng)暫時停止輸注或降低輸注速度。女： BEE(kcal/24h)=++。 內(nèi)容總結(jié) 中毒危重癥患者 的營養(yǎng)支持。 (Based on 9 level 1 studies and 19 level 2 studies, when parenteral nutrition is prescribed to critically ill patients, parenteral supplementation with glutamine should be considered. However, we strongly remend that glutamine NOT be used in critically ill patients with shock and multian failure [refer to section b]. There are insufficient data to generate remendations for intravenous glutamine in critically ill patients receiving EN.) 加拿大重癥營養(yǎng)支持指南 2024更新推薦意見 降級意見 第五十六頁，共五十八頁。 (Based on 5 level 2 studies, when initiating enteral feeds, the use of whole protein formulas [polymeric] should be considered.) ? 4)基于 9項 1級和 19項 2級研究結(jié)果， 接受腸外營養(yǎng)的重癥病人應(yīng)考慮補充谷氨酰胺 ，但強烈推薦對于休克與多臟器功能衰竭病人不適用谷氨酰胺。 (No changes from 2024 but a caution against the use of any glutamine in patients with shock and MOF was added given the possibility of harm as demonstrated by the results of the REDOXS study of bined enteral and parenteral glutamine.) 加拿大重癥營養(yǎng)支持指南 2024更新推薦意見 降級意見 第五十五頁，共五十八頁。 ? 1)基于 2項 1級研究和 5項 2級研究， ALI及 ARDS病人可選擇含魚油、琉璃苣油和抗氧化劑的腸內(nèi)營養(yǎng)制劑。 ? 3)推薦重癥病人靜脈或腸外營養(yǎng)途徑補充硒制劑或聯(lián)合其他抗氧化劑。(Based on 3 level 1 and 20 level 2 studies, the use of probiotics should be considered in critically ill patients.) ? 2)接受腸外營養(yǎng)支持的病人，建議降低 ω6脂肪酸〔大豆油脂肪乳劑〕補充量，但尚無充分證據(jù)推薦降低局部應(yīng)用何類脂肪酸替代。 (There are insufficient data to make a remendation for the use of Vitamin D in critically ill patients.) 加拿大重癥營養(yǎng)支持指南 2024更新推薦意見 添加意見 第五十二頁，共五十八頁。 (Based on one level 1 study, we strongly remend that high dose bined parenteral and enteral glutamine supplementation NOT be used in critically ill patients with shock and multian failure.) ? 9)尚無充分證據(jù)推薦重癥病人應(yīng)用低劑量碳水化合物飲食并聯(lián)合胰島素治療。 (We strongly remend that early supplemental PN and high IV glucose not be used in unselected critically ill patients [. low risk patients with short stay in ICU]. In the patient who is not tolerating adequate enteral nutrition, there are insufficient data to put forward a remendation about when PN should be initiated. Practitioners will have to weigh the safety and benefits of initiating PN in patients not tolerating EN on an individual casebycase basis.) 加拿大重癥營養(yǎng)支持指南 2024更新推薦意見 添加意見 第五十一頁，共五十八頁。 ? 7)較強的證據(jù)認為：對于低營養(yǎng)風險、 ICU留住時間短的危重病人，強烈建議不推薦早期添加腸外營養(yǎng)〔 SPN〕或／和靜脈補充大劑量葡萄糖制劑。 (There are insufficient data to make a remendation of 223。 (There are insufficient data to make a remendation to return gastric residual volumes up to a certain threshold in critically ill adult patients. Based on 1 level 2 studies, refeeding GRVs up to a maximum of 250 mls or discarding GRVs ma
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