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1、JPENGUIDELINEFORCRITICALCARENUTRITIONSUPPORTPresenter:Dr.歐軒甫Supervisor:Dr.陳奇祥本檔僅供內部教學使用檔案內所使用之照片之版權仍屬於原期刊公開使用時,須獲得原期刊之同意授權A.InitiateEnteralFeedingB.WhentoUseParenteralNutritionC.DosingofEnteralFeedingD.MonitoringToleranceandAdequacyofEnteralNutritionE.SelectionofAppropriateEnteralFormula
2、tionF.AdjunctiveTherapyG.WhenIndicated,MaximizeEfficacyofParenteralNutritionH.PulmonaryFailureI.RenalFailureJ.HepaticFailureK.AcutePancreatitisL.NutritionTherapyinEnd-of-LifeSituationsI.II.III.AcriticallyillICUpatientmaybeanappropriatecandidateforPNundercertaincircumstances:(1)wellnouris
3、hedpriortoadmission,butafter7daysofhospitalization,ENhasnotbeenfeasibleortargetgoalcalorieshavenotbeenmetconsistentlybyENalone.(2)Onadmission,thepatientismalnourishedandENisnotfeasible.(3)Amajorsurgicalprocedureisplanned,thepreoperativeassessmentindicatesthatENisnotfeasiblethroughtheperi
4、operativeperiod,andthepatientismalnourished.G.WHENINDICATED,MAXIMIZEEFFICACYOFPARENTERALNUTRITIONIfENisnotavailableorfeasible,theneedforPNtherapyshouldbeevaluated(Grade:C)IfthepatientisdeemedtobeacandidateforPN,stepstomaximizeefficacy(regardingdose,content,monitoring,andchoiceofsupplemen
5、taladditives)shouldbeused.(Grade:C)HyperglycemiaImmunsupressionOxidativeStressInfect.MorbidityInallICUpatientsreceivingPN,mildpermissiveunderfeedingshouldbeconsideredatleastinitially.Onceenergyrequirementsaredetermined,80%oftheserequirementsshouldserveastheultimategoalordoseofparenteralf
6、eeding.(Grade:C)Eventually,asthpatientstabilizes,PNmaybeincreasedtomeetenergrequirements.(Grade:E)Forobesepatients(BMI≥30),thedoseofPNwithregardtoproteinandcaloricprovisionshouldfollowthesamerecommendationsgivenforENinguidelineC5.(Grade:D)C5:BMI>30thegoaloftheEN≤60%-70%oftargetenergyrequ
7、irementsor11-14kcal/kg/day(or22-25kcal/kgidealbodyweightperday).Proteinshouldbeprovidedinarange≥2.0g/kgidealbodyweightperdayforClassIandIIpatients(BMI30-40),≥2.5g/kgidealbodyweightperdayforClassIII(BMI≥40).“PERMISSIVEUNDERFEEDING”Thisstrategy↓thepotentialfor--insulinresis
