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.
根据专家共识,建议血流动力学稳定的内科与外科ICU患者,可考虑添加发酵性可溶性纤维(如低聚果糖[FOSs], 菊粉)。合并腹泻患者推荐添加10-20g可溶性纤维,于24小时内分次给予。
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]
虽然研究所用的益生菌类别与菌种在综合ICU患者显示是安全的,但也仅限用于那些RCT研究证实安全且有益预后的内外科患者,目前尚不能推荐此范围以外ICU患者常规使用益生菌制剂。
[证据质量: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]
对于需要特殊营养治疗的重症患者,我们建议依据报道的安全剂量补充抗氧化维生素与微量元素。
[证据质量:低]
F4. We suggest that supplemental enteral glutamine NOT be added to an en regimen routinely in critically ill patients.
[Quality of Evidence: Moderate]
我们建议肠内补充谷氨酰胺不应纳入危重症患者EN的常规处方中。
[证据质量: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]
我们建议,对于低营养风险(如:NRS-2002≤3或NUTRIC评分≤5)、不适宜早期肠内营养、且入ICU 7天仍不能保证经口摄食量的患者,7天后给予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.
根据专家共识,确定存在高营养风险(如:NRS-2002≥5或NUTRIC评分 ≥6)或严重营养不良的患者,如果EN不可行,我们建议入ICU后尽早开始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]
无论低或高营养风险患者,接受肠内营养7-10天,如果经EN摄入能量与蛋白质量仍不足目标的60%,我们推荐应考虑给予补充型PN。在开始EN7天内给予补充型PN,不仅不能改善预后,甚至可能有害。
[证据质量: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.
根据专家共识,我们建议使用营养支持实施方案与营养支持小组,以促进营养支持策略的最大化获益并降低PN相关风险。
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]
对于高营养风险或严重营养不良、需要PN支持的患者,我们建议住ICU第一周内给予低热卡PN(≤20 kcal/kg/day 或能量需要目标的80%),以及充分的蛋白质补充(≥ 1.2 g/kg/day)。
[证据质量: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]
危重病患者开始PN的第一周,我们建议暂缓或限制大豆油基础的静脉脂肪乳剂输注,如果考虑必需脂肪酸缺乏,其最大补充剂量为100g/每周(常分2次补充)。
[证据质量: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比大豆油基础的IVFE对预后具有更好影响;但是,鉴于美国这类产品的缺乏,故尚不能做出任何推荐意见。根据专家意见,一旦这类脂肪乳剂(SMOF, MCT, OO, FO)在美国上市,建议在有PN适应症的重症患者使用。
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.
根据专家共识,标准商品化的PN制剂(多腔袋)与配置PN液相比,未见任何影响ICU患者临床结局的优势。
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]
我们推荐综合ICU患者的血糖控制目标在:140–180 或 150–180 mg/dl;特殊患者(心血管术后,颅脑损伤)可能有超出指南的不同推荐。
[证据质量:中]
H6. We recommend that parenteral glutamine supplementation NOT be used routinely in the critical care setting.
[Quality of Evidence: Moderate]
我们推荐危重病患者肠外营养期间无需常规补充谷氨酰胺。
[证据质量: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.
根据专家共识,当EN耐受性提高,达到目标能量60%以上时,我们建议经PN途径供给的能量可逐渐减量至终止。
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