【持续性肾脏替代治疗CRRT英文ppt课件】JPEN GUIDELINE FOR CRITICAL CARE NUTRITION SUPPORT.ppt

JPEN GUIDELINE FOR CRITICAL CARE NUTRITION SUPPORT;A. Initiate Enteral Feeding B. When to Use Parenteral Nutrition C. Dosing of Enteral Feeding;A critically ill ICU patient may be an appropriate candidate for PN under certain circumstances: (1) well nourished prior to admission, but after 7 days of hospitalization, EN has not been feasible or target goal calories have not been met consistently by EN alone. (2) On admission, the patient is malnourished and EN is not feasible. (3) A major surgical procedure is planned, the preoperative assessment indicates that EN is not feasible through the perioperative period, and the patient is malnourished.;In all ICU patients receiving PN, mild permissive underfeeding should be considered at least initially. Once energy requirements are determined, 80% of these requirements should serve as the ultimate goal or dose of parenteral feeding. (Grade: C);“PERMISSIVE UNDERFEEDING”;;Soy-based 18-carbon ω-6 fatty acid preparation, in North America Soy-based lipid-free (vs. lipid-containing) PN: ↓ infectious morbidity (pneumonia and catheter-related sepsis), ↓ hospital and ICU length of stay, ↓ duration of mechanical ventilation;;Strict glucose control (BS: 80 ~ 110 mg/dL) v.s. conventional insulin therapy (BS 200 mg/dL): ↓ sepsis, ↓ ICU length of stay, and ↓ hospital mortality.;;The addition of parenteral glutamine (at a dose of 0.5 g/kg/d) to a PN regimen has been shown to ↓ infectious complications, ICU length of stay, and mortality in critically ill patients, compared to the same PN regimen without glutamine.;;GLUTAMINE;In patients stabilized on PN, periodically repeated efforts should be made to initiate EN. ;H. PULMONARY FAILURE;Fluid accumulation and pulmonary edema are common in patients with acute respiratory failure and have been associated with poor clinical outcomes. It is therefore suggested that a fluid-restricted calorically dense nutrient formulation (1.5-2.0 kcal/mL) be considered for patients with acute respiratory f