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首页> 外文期刊>Nutrition in clinical practice : >Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations
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Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

机译：重症小儿患者连续性肾脏替代治疗期间营养治疗的修改：叙事回顾和建议

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Introduction Nutrition is an important part of treatment in critically ill children. Clinical guidelines for nutrition adaptations during continuous renal replacement therapy (CRRT) are lacking. We collected and evaluated current knowledge on this topic and provide recommendations. Methods Questions were produced to guide the literature search in the PubMed database. Results Evidence is scarce and extrapolation from adult data was often required. CRRT has a direct and substantial impact on metabolism. Indirect calorimetry is the preferred method to assess resting energy expenditure (REE). Moderate underestimation of REE is common but not clinically relevant. Formula‐based calculation of REE is inaccurate and not validated in critically ill children on CRRT. The nutrition impact of nonintentional calories delivered as citrate, lactate, and glucose during CRRT must be considered. Quantifying nitrogen balance is not feasible during CRRT. Protein delivery should be increased by 25% to compensate for losses in the effluent. Fats are not removed by CRRT and should not be adapted during CRRT. Electrolyte disturbances are frequently present and should be treated accordingly. Vitamins B1, B6, B9, and C are lost in the effluent and should be adapted to the effluent dose. Trace elements, with the exception of selenium, are not cleared in relevant quantities. Manganese accumulation is of concern because of potential neurotoxicity. Conclusion Current recommendations regarding nutrition support in pediatric CRRT must be extrapolated from adult studies. Recommendations are provided, based on the weak level of evidence. Additional research on this topic is warranted.
机译：简介营养是重症儿童治疗的重要组成部分。缺乏连续肾脏替代疗法（CRRT）期间营养适应的临床指南。我们收集并评估了有关此主题的最新知识，并提供了建议。方法提出问题以指导PubMed数据库中的文献检索。结果证据稀少，通常需要从成人数据中推断。 CRRT对新陈代谢具有直接而实质的影响。间接量热法是评估静息能量消耗（REE）的首选方法。 REE的中度低估很常见，但在临床上不相关。在CRRT的重症儿童中，基于公式的REE计算不准确，未经验证。必须考虑CRRT期间以柠檬酸盐，乳酸盐和葡萄糖形式传递的非故意卡路里的营养影响。在CRRT期间量化氮平衡是不可行的。蛋白质输送量应增加25％，以补偿废水中的损失。 CRRT不能去除脂肪，CRRT期间不宜进行调整。电解质干扰经常存在，应​​相应地进行处理。维生素B1，B6，B9和C在废水中损失掉，应适应废水剂量。除硒外，痕量元素均未清除。锰的积累由于潜在的神经毒性而受到关注。结论必须从成人研究中推断出目前有关小儿CRRT营养支持的建议。根据证据不足的水平提供了建议。有必要对此主题进行其他研究。

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