ICU領域の脂肪投与について

熱傷患者では鎮静薬としてPropofolを使用するケースが多い。

ESPENガイドラインでは、以下のように指摘投与量を提示している。

ESPEN endorsed recommendations: Nutritional therapy in major burns

3.5. Lipids

Small amounts of fat are required to prevent essential fatty acid deficiency: only few studies are available regarding lipid re- quirements in burns. The two available studies47,48 show that burn patients seem to be particularly sensitive to the total lipid load. Negative impact on hospital length of stay and on infection risk have been reported with total lipids intakes reaching 35% of energy requirements compared with 15%. As the current industrial prep- arations provide 30-52% of total energy as fat, the limitation of fat intakes requires hospital compounding. Due to this apparent sensitivity, it is also recommended to monitor the non-nutritional lipid intakes, such as delivered with the sedative propofol, which can reach 15-30 g/day in adults.

引用論文は以下の2つ
47.Bernier J, Jobin N, Emptoz-Bonneton A, Pugeat MM, Garrel DR. Decreased corticosteroid-binding globulin in burn patients: relationship with interleukin- 6 and fat in nutritional support. Crit Care Med 1998;26:452e60.
48.Garrel DR, Razi M, Larivière F, Jobin N, Naman N, Emptoz-Bonneton A, et al. Improved clinical status and length of care with low-fat nutrition support in burn patients. J Parenteral Enteral Nutr 1995;19:482e91.

総エネルギーの15%vs35%だと35%グループでLOS、感染症発症率が増加との結論。また、脂質の種類については現時点も効果は不明。
日本人の食事摂取基準等では25-30%で提言。

ICU領域で使用することの多い経管栄養剤は、昨今では糖質比率を下げ、蛋白比率、脂質比率はむしろ高めに設定されている。
一般組成の栄養剤はほぼ25%だが、脂質比率を高めている栄養剤の使用時にはpropofol内の脂質含有量を加味することが必要になる。

目標投与量を詳細に決定し、栄養剤選択まで指南してくれる便利なサイトを発見
http://www.surgicalcriticalcare.net/Resources/burn_nutrition.php

今度はpropofolの有害事象ならびにLOS、感染症発症率の増加について詳しく調べてみよう

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