临床时讯 ＞ 临床研究
“CAN WE FEED？”融合危重患者营养与重症监护评估
对于危重患者的护理变得越来越复杂，因此，重症监护医师需要渊博的知识以提供优质的服务。营养是错综复杂的护理中的其中一个领域，有可能显著改善患者的治疗效果。已证实应用记忆法可成功区分在复杂的决策制定过程中必须考虑的信息。作者提出助记符“CAN WE FEED？”以协助重症监护病房（ICU）患者开发并启动早期肠内营养治疗。当危重患者进入ICU时，履行的基线评估应考虑重症患者疾病的严重度（C）、年龄（A）及营养风险筛查（N）。等待复苏（W）是在大多数危重患者护理的关键组分，也是开始喂养前一个重要的考量。用常规的以体重为基础的方程、间接测热法或这两种技术的组合来确定能量需求（E）。接着是营养支持更实际的问题，包括配方的选择（F），肠道通路（E），疗效（E）及确定耐受性（D）。通过使用助记符“CAN WE FEED？”仔细斟酌这些内容，重症监护医师可成功地实施营养计划，临床营养学家能理解对重症患者复苏初期适当的营养干预及治疗。
JPEN J Parenter Enteral Nutr. 2011 Sep;35(5):643-59.
"CAN WE FEED?" A mnemonic to merge nutrition and intensive care assessment of the critically ill patient.
Miller KR, Kiraly LN, Lowen CC, Martindale RG, McClave SA.
Department of Surgery, University of Louisville, Louisville, KY 40202, USA.
As care of the critically ill patient grows more complex, so does the breadth of knowledge required of the intensivist to deliver quality service. Nutrition is one area of many where the complexity of care has grown and the opportunity for improving patient outcomes has become evident. The use of mnemonics has proven successful in compartmentalizing information that must be considered in complex decision-making processes. The authors propose one such mnemonic, "CAN WE FEED?" to assist in the development and initiation of early enteral nutrition therapy in the intensive care unit (ICU). Critical illness severity (C), age (A), and nutrition risk screening (N) are considered when performing a baseline evaluation of the critically ill patient upon presentation to the ICU. Wait for resuscitation (W) is a key component in the care of most critically ill patients and is an important consideration prior to the initiation of feeding. Energy requirements (E) are determined using conventional weight-based equations, indirect calorimetry, or combinations of both techniques. The more practical aspects of support that follow include formula selection (F), enteral access (E), efficacy (E), and the determination of tolerance (D). With careful consideration of these components through the use of the mnemonic "CAN WE FEED?" the intensivist can successfully implement a nutrition plan, and the clinical nutritionist can appreciate where nutrition therapy appropriately intervenes in the initial resuscitation and management of the critically ill patient.