ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－176－IL12Chairman, Intensive Care Department Medical Director, Respiratory Services Professor, College of Medicine King Saud BinAbdulaziz University for Health Sciences King Abdulaziz Medical City Riyadh, Kingdom of Saudi ArabiaYaseen ArabiNutritional support is an essential component of the management of critically ill adults. However, the optimal caloric intake hasnever been examined systematically and remains an enigma. Several studies have showed that low caloric intake may bedetrimental and that higher caloric intake may be associated with improved outcomes. Conversely, in other studies it wassuggested that caloric restriction may be beneficial in critically ill patients if adequate dietary protein is provided. These findingsprompted the question of whether moderate caloric restriction while preserving protein intake improves the outcomes ofcritically ill adults compared to standard feeding. In our previous single-center RCT of moderate（60-70%）versus standard（90-100%）caloric intake while maintaining full protein target in both groups, it was observed that the lesser caloric intake wasassociated with a reduction in hospital and 180-day mortality, both of which were secondary endpoints.In a more recent multicentric study, we evaluated the impact of permissive underfeeding versus standard enteral feeding on 90-day mortality preserving the protein intake. We set our caloric goal in the permissive underfeeding group at a lower level（40-60% of caloric requirement）than the earlier trial with the premise that a larger separation in caloric intake between the twogroups would lead to a larger treatment effect. Throughout the intervention period, the permissive underfeeding group receivedfewer calories than the standard feeding group（ 835±297 versus 1299±467 kcal/day, respectively, p<0.001; 46±14% versus71± 22% caloric requirements respectively, p<0.001）. Protein intake was similar between groups（57± 24 versus 59 ± 25 g/day,p=0.22）. It was found that the 90-day mortality was similar -- 121/445 patients（27.2%）versus 127/440 patients（28.9%）in thepermissive and standard feeding groups, respectively（relative risk 0.94, 95% confidence interval 0.76, 1.16, p=0.58）. Enteralfeeding to deliver moderate calories to critically ill adults was not associated with lower mortality compared to planned deliveryof full caloric requirements.招聘講演 12 2月13日（土）　15：40～16：30　第12会場Nutritional support in critically ill patientsIL13Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,KoreaYounsuck KohIntensive care medicine is often seen as a discipline focused on pulling back critically ill patients from the brink of death.Unfortunately, however, critical illness is a painful experience, and many patients in the intensive care unit（ICU）do notsurvive. Many ethical questions on the use of life-sustaining treatments for terminally ill patients thus exist. It is thereforecrucial that good intensive care, palliative care, and end-of-life care co-exist in the ICU.Asia accounts for at least half of all patients with critical illness, mechanical ventilation, and ICU deaths internationally; yet, dataon end-of-life care in Asian ICUs are comparatively sparse and only beginning to emerge. This talk will discuss what wecurrently know of the attitudes and practice of physicians who manage critically ill patients in Asia at the end of life, includingtheir views on withholding and withdrawal of life-sustaining treatments.招聘講演 13 2月14日（日）　9：00～9：50　第2会場End-of-life care in Asian ICUs