《成人重症患者营养支持疗法提供与评定指南》修订版的实践应用：病例研究

　　2016年2月，美国肠外肠内营养学会（ASPEN ）和重症医学会（SCCM）联合发表了经过修订的2016年版《成人重症患者营养支持疗法提供与评定指南》，分别刊登于ASPEN官方期刊《肠外肠内营养杂志》（JPEN）和SCCM官方期刊《重症医学》（CCM）。该指南面向医师、护士、营养师和药师，针对重症成人（18岁以上）患者，提供了最佳营养疗法的最新建议，协助医疗团队提供适当的营养疗法，可以减少并发症、缩短住院时间、降低疾病严重程度、改善患者结局。

　　2016年4月，针对《成人重症患者营养支持疗法提供与评定指南》修订版的实践应用，ASPEN官方期刊《营养临床实践》（NCP）在线发表了俄勒冈波特兰退伍军人医学中心、华盛顿马迪根军事医学中心、俄克拉何马大学医学院的病例研究。

Nutr Clin Pract. 2016 Apr 12. [Epub ahead of print]

Practical Application of the Revised Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: A Case Study Approach.

Warren M, McCarthy MS, Roberts PR.

• Portland VA Medical Center, Portland, Oregon, USA.

• Madigan Army Medical Center, Tacoma, Washington, USA.

• University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA.

BACKGROUND: Nutrition therapy is an essential component of the care plan for critically ill and injured patients. There is consensus that critically ill patients are at risk for malnutrition, and the associated consequences of increased infectious morbidity, multiorgan dysfunction, prolonged hospitalization, and disproportionate mortality can be minimized with specialized enteral and/or parenteral nutrition therapy.

METHODS: In this article, we describe 2 case studies that are intended to introduce the nutrition support clinician to key updates in the recently released Guidelines for 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.).

RESULTS: The case studies demonstrate a pragmatic approach to nutrition therapy in the intensive care unit (ICU) and are intended to elicit dialogue for timely, appropriate nutrition care at policy meetings, professional conferences, and ICU daily rounds.

CONCLUSIONS: While explicitly stated in the formal document, it is worth repeating that the guidelines are directed toward generalized patient populations, but as with any therapeutic intervention in the ICU, nutrition therapy should be tailored to the individual patient. In addition, protocols and procedures should reflect the local institutional culture and meet with approval of critical care clinicians.

TRIAL REGISTRATION: ClinicalTrials.gov .

KEYWORDS: critical care; critical illness; enteral nutrition; intensive care units; nutritional support; parenteral nutrition; practice guidelines

PMID: 27072854

PII: 0884533616640451

DOI: 10.1177/0884533616640451