危重患者肠内与肠外营养选择.pptVIP

B 开始肠内营养 Question: Is EN safe during periods of hemodynamic instability in adult critically ill patients? 问题：对于成年危重病患者，血流动力学不稳定时EN是否安全？ B5. Based on expert consensus, we suggest that in the setting of hemodynamic compromise or instability, EN should be withheld until the patient is fully resuscitated and/or stable. Initiation/reinitiation of EN may be considered with caution in patients undergoing withdrawal of vasopressor support. 根据专家共识，我们建议在血流动力学不稳定时，应当暂停EN直至患者接受了充分的复苏治疗和（或）病情稳定。对于正在撤除升压药物的患者，可以考虑谨慎开始或重新开始EN。 C 肠内营养剂量 Question: What population of patients in the ICU setting does not require nutrition support therapy over the first week of hospitalization? 问题：哪些患者住ICU的第一周内无需营养支持治疗？ C1. Based on expert consensus, we suggest that patients who are at low nutrition risk with normal baseline nutrition status and low disease severity (for example, NRS-2002 ≤ 3 or NUTRIC score ≤ 5) who cannot maintain volitional intake do NOT require specialized nutrition therapy over the first week of hospitalization in the ICU. 根据专家共识，我们建议那些营养风险较低及基础营养状况正常、疾病较轻（例如NRS-2002 ≤ 3 或 NUTRIC评分≤ 5）的患者，即使不能自主进食，住ICU的第一周内不需要特别给予营养治疗。 C 肠内营养剂量 Question: For which population of patients in the ICU setting is it appropriate to provide trophic EN over the first week of hospitalization? 问题：哪些ICU患者在住院第一周内适合滋养型喂养 (trophic EN)？ We recommend that either trophic or full nutrition by EN is appropriate for patients with acute respiratory distress syndrome (ARDS)/acute lung injury (ALI) and those expected to have a duration of mechanical ventilation ≥ 72 hours, as these two strategies of feeding have similar patient outcomes over the first week of hospitalization. [Quality of Evidence: High] 对于急性呼吸窘迫综合征(ARDS)/急性肺损伤(ALI)患者以及预期机械通气时间≥ 72小时的患者，我们推荐给予滋养型或充分的肠内营养，这两种营养补充策略对患者住院第一周预后的影响并无差异。 ［证据质量：高］ trophic EN (defined as 10–20 kcal/hr or up to 500 kcal/day) for one week C 肠内营养剂量 Question: What population of patients in the ICU requires full EN (as close as possible to target nutrition goals) beginning in the fir