Krishnan Jerry A, Parce Pat B, Martinez Anthony, Diette Gregory B, Brower Roy G
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
Chest. 2003 Jul;124(1):297-305. doi: 10.1378/chest.124.1.297.
To assess the consistency of caloric intake with American College of Chest Physicians (ACCP) recommendations for critically ill patients and to evaluate the relationship of caloric intake with clinical outcomes.
Prospective cohort study.
Adult ICUs at two teaching hospitals.
Patients with an ICU length of stay of at least 96 h.
On ICU admission, severity of illness (ie, simplified acute physiology score II) and markers of nutritional status (ie, serum albumin level and body mass index) were recorded. The route of feeding (ie, enteral or parenteral), actual caloric intake (ie, percentage of ACCP recommendations: 0 to 32% [tertile I]; 33 to 65% [tertile II]; >/==" BORDER="0"> 66% [tertile III]), and evidence of GI intolerance (ie, gastric aspirate levels, >/==" BORDER="0"> 100 mL) were recorded daily. The following outcomes were assessed: status on hospital discharge (alive vs dead); spontaneous ventilation before ICU discharge (yes vs no); and ICU discharge without developing nosocomial sepsis (yes vs no). The average caloric intake among 187 participants was 50.6% of the ACCP targets and was similar in both hospitals. Caloric intake was inversely related to the mean number of gastric aspirates >/==" BORDER="0"> 100 mL/d (Spearman rho = -0.04; p = 0.06), but not to severity of illness, nutritional status, or route of feeding. After accounting for the number of gastric aspirates >/==" BORDER="0"> 100 mL, severity of illness, nutritional status, and route of feeding, tertile II of caloric intake (vs tertile I) was associated with a significantly greater likelihood of achieving spontaneous ventilation prior to ICU discharge. Tertile III of caloric intake (vs tertile I) was associated with a significantly lower likelihood of both hospital discharge alive and spontaneous ventilation prior to ICU discharge.
Study participants were underfed relative to ACCP targets. These targets, however, may overestimate needs, since moderate caloric intake (ie, 33 to 65% of ACCP targets; approximately 9 to 18 kcal/kg per day) was associated with better outcomes than higher levels of caloric intake.
评估危重症患者的热量摄入与美国胸科医师学会（ACCP）建议的一致性，并评估热量摄入与临床结局的关系。
前瞻性队列研究。
两家教学医院的成人重症监护病房。
入住重症监护病房至少96小时的患者。
在入住重症监护病房时，记录疾病严重程度（即简化急性生理学评分II）和营养状况指标（即血清白蛋白水平和体重指数）。每天记录喂养途径（即肠内或肠外）、实际热量摄入（即ACCP建议的百分比：0至32%[三分位数I]；33至65%[三分位数II]；> / == " BORDER = "0"> 66%[三分位数III]）以及胃肠道不耐受的证据（即胃吸出物水平，> / == " BORDER = "0"> 100 mL）。评估以下结局：出院时状态（存活与死亡）；重症监护病房出院前自主通气情况（是与否）；以及重症监护病房出院时未发生医院感染性脓毒症（是与否）。187名参与者的平均热量摄入为ACCP目标的50.6%，两家医院相似。热量摄入与平均每日胃吸出物> / == " BORDER = "0"> 100 mL的次数呈负相关（Spearman秩相关系数=-0.04；p = 0.06），但与疾病严重程度、营养状况或喂养途径无关。在考虑了每日胃吸出物> / == " BORDER = "0"> 100 mL的次数、疾病严重程度、营养状况和喂养途径后，热量摄入三分位数II（相对于三分位数I）与重症监护病房出院前实现自主通气的可能性显著增加相关。热量摄入三分位数III（相对于三分位数I）与出院时存活以及重症监护病房出院前自主通气的可能性显著降低相关。
相对于ACCP目标，研究参与者存在热量摄入不足的情况。然而，这些目标可能高估了需求，因为适度的热量摄入（即ACCP目标的33%至65%；约每天9至18千卡/千克）与比更高热量摄入更好的结局相关。
