21. N Engl J Med 2011; Ven den Berghe Early vs. Late PN in Critically Ill Adults 存在营养不良风险的重症患者，早期（入 ICU 第 1 周）添加 PN vs. 延迟至 8 天后再添加 PN ，延迟添加组使感染并发症和医疗花费很少
33. The GAP between prescription and practical EN intake Prolonged ICU stay, discharged weak and debilitated. Dvir Clin Nutr 2006; Petros Clin Nutr 2006
34.
35.
36.
37. 加强评估与营养支持整体管理 GI 功能评价 PN PN+EN TPN EN GI 功能再评价 充足的营养供给 TEN Y N Y Y N N 监测、评估营养供给充分与否和耐受性、评价器官功能
Hypothetical relationship of Starvation-related Malnutrition and Disease-related Malnutrition (bottom graph) assuming the inflammatory condition is relatively constant with changes in lean body mass. For SRM (Red color solid line), Lean body mass is depleted without nutritional intervention but this can be corrected with nutrition support (NS) (SRM+NS, Red color dotted line). During partial SRM (Blue color solid line), lean body mass depletion is slower but still may be reversed by nutrition support (Partial SRM+NS, Blue color dotted line).
For ADRM (Red color solid line), significant depletion of lean body mass over a short period of time (< 1 month) occurs with no nutritional intervention. With nutritional intervention (Red color dotted line), the loss in lean body mass is abated but loss still occurs if inflammation persists. For CDRM (Blue color dotted line), the loss in lean body mass is gradual and will eventually reach detrimental levels over time (several months). This process could be slowed or potentially reversed with nutritional interventions. In both scenarios, ADRM and CDRM, nutritional intervention may be beneficial but with success dependent on the degree and duration of the inflammatory response. Key: ADRM, acute disease- or injury-related malnutrition; ADRM+NS, ADRM with nutrition support; CDRM, chronic disease-related malnutrition; CDRM+NS, CDRM with nutrition support; SRM, starvation-related malnutrition; SRM+NS, SRM with nutrition support. SRM- starvation-related malnutrition, SRM+NS- starvation-related malnutrition with nutrition support.
Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons,
适宜的时机选择 The treatment of disease with novel pharmacologic agents
potentially new and different therapeutic goal to modulate the systemic inflammatory response might be more effectively accomplished for the first week post injury by hypocaloric feedings (~9–18 kcal/kg or 50%–75% resting metabolic expenditure) principally as intravenous dextrose but with at least 1 g/kg protein as intravenous amino acids to provide early metabolic support
route of nutrition, topics related to EN (use and timing, indirect calorimetry, dose, composition and strategies to optimize delivery and minimize risks, tolerance and other), PN topics (combination parenteral and enteral, parenteral vs standard care, composition, strategies to optimize delivery and minimize risks), and supplemental antioxidants and minerals.
Adequate gut function
The intestine’s impact on health. The gastrointestinal tract contributes to health by ensuring digestion and absorption of nutrients, minerals and fluids; by induction of mucosal and systemic tolerance; by defence of the host against infectious and other pathogens; and by signalling from the periphery to the brain. For details and references, see text ‘Underlying mechanisms’.
Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons,
Legend: Odds of 60-day Mortality per 1000 kcals received per day adjusting for nutrition days, BMI, age, admission category, admission diagnosis and APACHE II score.
(84~104 KJ)
（恢复期活动 ）
data-driven care to optimize delivery of nutrition to the diverse population of sick patients Key topics reviewed in this issue include how many calories should be fed and by what route, data for the use of specific nutrients, and finally how to evaluate the plethora of often conflicting nutritional guidelines that exist in critical care.
