Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Bench-to-bedside review: Metabolism and nutrition. | Available online http content 12 4 222 Review Bench-to-bedside review Metabolism and nutrition Michael P Casaer Dieter Mesotten and Miet RC Schetz Department of Intensive Care Medicine University Hospital Leuven Catholic University of Leuven Herestraat 49 B-3000 Leuven Belgium Corresponding author Michael P Casaer Published 19 August 2008 Critical Care 2008 12 222 doi cc6945 This article is online at http content 12 4 222 2008 BioMed Central Ltd Abstract Acute kidney injury AKI develops mostly in the context of critical illness and multiple organ failure characterized by alterations in substrate use insulin resistance and hypercatabolism. Optimal nutritional support of intensive care unit patients remains a matter of debate mainly because of a lack of adequately designed clinical trials. Most guidelines are based on expert opinion rather than on solid evidence and are not fundamentally different for critically ill patients with or without AKI. In patients with a functional gastrointestinal tract enteral nutrition is preferred over parenteral nutrition. The optimal timing of parenteral nutrition in those patients who cannot be fed enterally remains controversial. All nutritional regimens should include tight glycemic control. The recommended energy intake is 20 to 30 kcal kg per day with a protein intake of to g kg per day. Higher protein intakes have been suggested in patients with AKI on continuous renal replacement therapy CRRT . However the inadequate design of the trials does not allow firm conclusions. Nutritional support during CRRT should take into account the extracorporeal losses of glucose amino acids and micronutrients. Immunonutrients are the subject of intensive investigation but have not been evaluated specifically in patients with AKI. We suggest a protocolized nutritional strategy delivering enteral nutrition whenever possible and providing at least the daily requirements of .
