Ibrahim Emad H, Mehringer Lisa, Prentice Donna, Sherman Glenda, Schaiff Robyn, Fraser Victoria, Kollef Marin H
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
JPEN J Parenter Enteral Nutr. 2002 May-Jun;26(3):174-81. doi: 10.1177/0148607102026003174.
This study sought to compare 2 strategies for the administration of enteral feeding to mechanically ventilated medical patients.
The prospective, controlled, clinical trial was carried out in a medical intensive care unit (19 beds) in a university-affiliated, urban teaching hospital. Between May 1999 and December 2000, 150 patients were enrolled. Patients were scheduled to receive their estimated total daily enteral nutritional requirements on either day 1 (early-feeding group) or day 5 (late-feeding group) of mechanical ventilation. Patients in the late-feeding group were also scheduled to receive 20% of their estimated daily enteral nutritional requirements during the first 4 days of mechanical ventilation.
Seventy-five (50%) consecutive eligible patients were entered into the early-feeding group and 75 (50%) patients were enrolled in the late-feeding group. During the 5 five days of mechanical ventilation, the total intake of calories (2370 +/- 2000 kcal versus 629 +/- 575 kcal; p < .001) and protein (93.6 +/- 77.2 g versus 26.7 +/- 26.6 g; p < .001) were statistically greater for patients in the early-feeding group. Patients in the early-feeding group had statistically greater incidences of ventilator-associated pneumonia (49.3% versus 30.7%; p = .020) and diarrhea associated with Clostridium difficile infection (13.3% versus 4.0%; p = .042). The early-feeding group also had statistically longer intensive care unit (13.6 +/- 14.2 days versus 9.8 +/- 7.4 days; p = .043) and hospital lengths of stay (22.9 +/- 19.7 days versus 16.7 +/- 12.5 days; p = .023) compared with patients in the late-feeding group. No statistical difference in hospital mortality was observed between patients in the early-feeding and late-feeding groups (20.0% versus 26.7%; p = .334).
The administration of more aggressive early enteral nutrition to mechanically ventilated medical patients is associated with greater infectious complications and prolonged lengths of stay in the hospital. Clinicians must balance the potential for complications resulting from early enteral feeding with the expected benefits of such therapy.
本研究旨在比较两种给机械通气内科患者进行肠内营养的策略。
这项前瞻性、对照临床试验在一所大学附属城市教学医院的内科重症监护病房（19张床位）进行。1999年5月至2000年12月期间，共纳入150例患者。患者被安排在机械通气的第1天（早期喂养组）或第5天（晚期喂养组）接受其估计的每日肠内营养总需求量。晚期喂养组的患者还被安排在机械通气的前4天接受其估计每日肠内营养需求量的20%。
75例（50%）连续符合条件的患者进入早期喂养组，75例（50%）患者进入晚期喂养组。在机械通气的5天期间，早期喂养组患者的热量总摄入量（2370±2000千卡对629±575千卡；p<.001）和蛋白质摄入量（93.6±77.2克对26.7±26.6克；p<.001）在统计学上更高。早期喂养组患者呼吸机相关性肺炎的发生率在统计学上更高（49.3%对30.7%；p=.020），以及与艰难梭菌感染相关的腹泻发生率更高（13.3%对4.0%；p=.042）。与晚期喂养组患者相比，早期喂养组在重症监护病房的住院时间在统计学上也更长（13.6±14.2天对9.8±7.4天；p=.043），以及住院总时长更长（22.9±19.7天对16.7±12.5天；p=.023）。早期喂养组和晚期喂养组患者的医院死亡率无统计学差异（20.0%对26.7%；p=.334）。
对机械通气内科患者给予更积极的早期肠内营养与更多的感染并发症及更长的住院时间相关。临床医生必须在早期肠内喂养导致并发症的可能性与这种治疗的预期益处之间取得平衡。
