Nutrition therapy in the intensive care unit · 2014-06-23 · Enteral nutrition is preferred over parenteral nutrition. Enteral nutrition should be initiated within 24 to48 hours
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496 대한의사협회지
FOCUSED ISSUE OF THIS MONTHJ Korean Med Assoc 2014 June; 57(6): 496-499
pISSN 1975-8456 / eISSN 2093-5951
http://dx.doi.org/10.5124/jkma.2014.57.6.496
서론
중환자치료 영역에서 영양평가(nutrition assessment) 및
치료는 간과되어서는 안될 중요한 영역 중 하나이다. 중환
자들은 질병자체로 인한 전신성염증반응증후군(systemic
inflammatory response syndrome)으로 인해 발생하는 스
트레스 호르몬과 염증매개체들은 이화상태(catabolism)를
일으켜 단백질분해(proteolysis) 등을 일으키며 임상적으로
감염률 증가, 상처치유 지연, 재원일수 증가, 사망률 증가 등
을 초래한다. 중환자실에서의 영양치료의 목표는 제지방체
중(lean body mass) 보전, 면역기능 보전, 대사적 합병증 최
소화로 단순한 열량지원뿐 아니라 대사변화를 고려한 영양
치료의 개념으로 확장되고 있다. 중환자의 영양치료에 대한
연구들이 활발히 이루어지면서 근거중심의 진료지침들이 체
계화되고 있다.
영양상태평가
중환자에서의 영양평가는 영양치료를 위한 중요한 단
계이다. 중환자에서 단백질열량영양부족(protein-energy
Nutrition therapy is challenging in critically ill patients. Critical illness is associated with a state of catabolic stress, in which stress hormones and inflammatory mediators are activated, resulting in proteolysis. The aim of nutrition therapy in critically ill patients is to preserve lean body mass, to preserve immune function, and to avoid metabolic complications. Enteral nutrition is preferred over parenteral nutrition. Enteral nutrition should be initiated within 24 to48 hours of intensive care unit admission. However, enteral nutrition should be withheld until the patient is fully resuscitated. If enteral nutrition is not feasible within several days, supplementary parenteral nutrition is necessary. In the acute phase, energy requirements should not be over 20 to 25 kcal/kg/d, and protein should be supplemented in the range of 1.2 to 2.0 g/kg/day. Monitoring tolerance is very important in critically ill patients with artificial nutrition to avoid complications. Immunonutrition such as glutamine and omega-3 fatty acid is helpful to modulate effects on the immune system in critically ill patients. Implementation of a feeding protocol and the involvement of a nutrition support team can systemize nutrition therapy. Together, these steps will hopefully enable the integration of evidence-based guidelines into practice, leading to improvements in nutrition performance so that patients’ chances of a good outcome are optimized.
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