Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,*,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,ESPEN Guidelines on EnteralNutrition:Intensive care,程俊峰,普外科,第一页，共二十一页Geriatrics,Liver disease,Surgery including organ transplantation,Wasting in HIV and other chronic infectious diseases,Adult renal failure,Gastroenterology,Pancreas,Cardiology and pulmonology,Non-surgical oncology,Intensive care,ESPEN,Guidelines,on,E,N:,ESPEN,Guidelines,on,P,N:,Geriatrics,Hepatology,surgery,C,ardiology and pneumology,Adult renal failure,Gastroenterology,Pancreas,home parenteral nutrition(HPN)in adult patients,第二页，共二十一页。
Summary,Enteral nutrition(EN)的定义及目的：,1、EN is the preferred way of feeding the critically ill patient and,counteracting for the catabolic state induced by severe diseases.,2、Intended to give evidence-based recommendations for the ICU patient,focusing particularly on those who develop a severe inflammatory,response,i.e.patients who have failure of at least one organ during,their ICU stay.,EN的 时机,(shj),及要求：,1、EN should be given to all ICU patients who are not expected to,be taking a full oral diet within three days.,2、the first 24 h using a standard high-protein formula.,the acute and initial phases 2025 kcal/kg/d（,exogenous energy）.,Recovery,2530 kcal/kg/d.,3、Glutamine should be supplemented in patients suffering from burns or,trauma.,第三页，共二十一页。
Subject,Recommendations,Grade,indication,All patients who are not expected to be on a,full oral diet within 3 days,C,Application,There are no data support using early EN can improve their,Prognosis，but the committee still recommend the early,（24h）appropriate amount of feeding,once the patient,have a haemo-dynamically stable and a functioning,gastrointestinal tract.,C,Exogenous energy supply:,the acute and initial phase:25kcal/kg/d less favourable,Recovery：25kcal/kg/d,C,severe under-nutrition：the EN energy supply should up to 25kcal/kg/d，if not reached，please add PN,C,If the patient intolerance(such as high gastric residuals)to,EN,metoclopramide（胃复安）or Erythromycin（红霉素）,should be considered.,C,Route,Use EN in patients who can be fed via the enteral route.,C,Via jejunal versus gastric feeding,there is no,significant difference.,C,If the patients tolerate EN and can reach the target energy value,PN should be avoid.,A,第四页，共二十一页。
Via EN can not be fed sufficiently,PN Should supplement,C,Type of formula,Whole protein formulae,are superior to,the peptide-based,formulae,C,Immune-modulating formulae(formulae enriched,with arginine(精氨酸),nucleotides（核苷酸）and w-3,fatty acids)are superior to standard enteral formulae:,In elective upper GI surgical patients;,in patients with a mild sepsis(APACHE,15);,in patients with severe sepsis,may be harmful and are not,Recommended;,in patients with trauma;,in patients with ARDS(formulae containing o-3,fatty acids and antioxidants).,A,B,B,A,B,Due to insufficient data,no recommendation support the,Immune-modulating formulae apply to the burned patients,but the trace elements(Cu,Se and Zn)should be,supplemented in a higher than standard dose,A,the severe illness ICU patients,should not receive an,immune-modulating formula enriched with arginine,nucleotides and w-3 fatty acids if the EN,700ml/d.,B,Glutamine should be added to standard enteral,formula in burned patients and trauma patients,A,第五页，共二十一页。
1.1 EN-when?,All patients（can not be on a full oral diet within 3 days）should receive EN（,C,）,a.It is unethical to investigate the maximum time of ICU patient,can survive without nutritional support.,b.Due to increased substrate metabolism（基础代谢,(jch di xi),）,the,critical illness is more likely to develop under-nutrition.,c.Scandinavian showed that the mortality rate of patient treat with,glucose only 250-300g/d over 14 days is 10 times higher on,adequate TPN.,d.so inadequate oral intake,the surgical patient is likely to,develop within 812 days of post-operation.,e.Most trials focusing the early EN or late EN after 46 days,have proved the positive effect of early EN,so we come to the,title conclusion.,第六页，共二十一页。
1.2 EN-Is early EN superior to delayed EN?,There are no data support using early EN can improve their prognosis，but,the committee still recommend the early(24h）appropriate amount of,feeding(,C,).,a.meta analysis,and,systematic review,A,meta analysis,of 15 RCTs(surgery,trauma,head injury,burns or suffering from,acute medical conditions),showed early EN can reduce the infectious,complications and length of stay.,systematic review,of 19 studies can show early EN play a positive effect on the,survival rate、length of treatment,the rate of septic.,and other complications，the conclusion provide 1 level evidence for using the,early EN.,b.Individual studies:(,recommendation level C),Moore and Jones,Graham和coworkers,Chiarelli et al,Eyer et al,Hasse et al,Singh et al,第七页，共二十一页。
No general amount recommend to be adjust EN therapy according to 。