2016重症营养常规与指南解读.pptVIP

D 肠内营养的耐受性与充分性 Question: How should tolerance of EN be monitored in the adult critically ill population? 问题：如何监测成年危重病患者EN耐受性？ D1. Based on expert consensus, we suggest that patients should be monitored daily for tolerance of EN. We suggest that inappropriate cessation of EN should be avoided. We suggest that ordering a feeding status of nil per os (NPO) for the patient surrounding the time of diagnostic tests or procedures should be minimized to limit propagation of ileus and to prevent inadequate nutrient delivery. 根据专家共识，我们建议应每日监测EN耐受性。我们建议应当避免不恰当的中止EN。我们建议，患者在接受诊断性检查或操作期间，应当尽可能缩短禁食状态(NPO)的医嘱，以免肠梗阻加重，并防止营养供给不足。 D 肠内营养的耐受性与充分性 Question: Should GRVs be used as a marker for aspiration to monitor ICU patients on EN? 问题：GRV是否应当作为接受EN的ICU患者监测误吸的指标？ D2a. We suggest that GRVs not be used as part of routine care to monitor ICU patients on EN. 我们建议不应当把GRV作为接受EN的ICU患者常规监测的指标。 ? D2b. We suggest that, for those ICUs where GRVs are still utilized, holding EN for GRVs 500 ml in the absence of other signs of intolerance (see section D1) should be avoided. [Quality of Evidence: Low] 我们建议，对于仍然监测GRV的ICU，应当避免在GRV 500 ml且无其他不耐受表现（见D1部分）时中止EN。 [证据质量：低] D 肠内营养的耐受性与充分性 Question: Should EN feeding protocols be used in the adult ICU setting? 问题：成人ICU是否需要制定EN喂养方案？ D3a. We recommend that enteral feeding protocols be designed and implemented to increase the overall percentage of goal calories provided. [Quality of Evidence: Moderate to High] 我们推荐制定并实施肠内营养喂养方案，以提高实现目标喂养的比例。 [证据质量：中至高] ? D3b. Based on expert consensus, we suggest that use of a volume-based feeding protocol or a top-down multi-strategy protocol be considered. D3b. 根据专家共识，我们建议考虑采用容量目标为指导的喂养方案或多重措施并举的喂养方案(top-down multi-strategy protocol)。 Topdown multi-strategy protocols typically use volume-based feeding in conjunction with prokinetic agents and post-pyloric tube placement initially (among other strategies), with prokinetic agents stopped in patients who demonstrate lack of need D 肠内营养的耐受性与充分性 Question: How can risk of