O'Leary-Kelley Colleen M, Puntillo Kathleen A, Barr Juliana, Stotts Nancy, Douglas Marilyn K
Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif., USA.
Am J Crit Care. 2005 May;14(3):222-31.
Inadequate nutritional intake in critically ill patients can lead to complications resulting in increased mortality and healthcare costs. Several factors limit adequate nutritional intake in intensive care unit patients given enteral feedings.
To examine the adequacy of enteral nutritional intake and the factors that affect its delivery in patients receiving mechanical ventilation.
A prospective, descriptive design was used to study 60 patients receiving enteral feedings at target or goal rate. Energy requirements were determined for the entire sample by using the Harris-Benedict equation; energy requirements for a subset of 25 patients were also determined by using indirect calorimetry. Energy received via enteral feeding and reason and duration of interruptions in feedings were recorded for 3 consecutive days.
Mean estimated energy requirements (8996 kJ, SD 1326 kJ) and mean energy intake received (5899 kJ, SD 3058 kJ) differed significantly (95% CI 3297-3787; P < .001). A total of 41 patients (68.3%) received less than 90% of their required energy intake, 18 (30.0%) received within +/-10%, and 1 (1.7%) received more than 110%. Episodes of diarrhea, emesis, large residual volumes, feeding tube replacements, and interruptions for procedures accounted for 70% of the variance in energy received (P<.001). Procedural interruptions alone accounted for 45% of the total variance. Estimated energy requirements determined via indirect calorimetry and mean energy received did not differ.
Most critically ill patients receiving mechanical ventilation who are fed enterally do not receive their energy requirements, primarily because of frequent interruptions in enteral feedings.
重症患者营养摄入不足会导致并发症，进而增加死亡率和医疗成本。在接受肠内喂养的重症监护病房患者中，有几个因素限制了充足的营养摄入。
研究接受机械通气患者的肠内营养摄入是否充足以及影响其供给的因素。
采用前瞻性描述性设计，对60例按目标或目标速率接受肠内喂养的患者进行研究。使用哈里斯-本尼迪克特方程确定整个样本的能量需求；还通过间接测热法确定了25例患者亚组的能量需求。连续3天记录通过肠内喂养获得的能量以及喂养中断的原因和持续时间。
平均估计能量需求（8996千焦，标准差1326千焦）与平均摄入能量（5899千焦，标准差3058千焦）差异显著（95%置信区间3297 - 3787；P <.001）。共有41例患者（68.3%）摄入的能量低于其所需能量的90%，18例（30.0%）摄入的能量在±10%以内，1例（1.7%）摄入的能量超过110%。腹泻、呕吐、大量残余量、喂养管更换以及手术中断等情况占所获能量差异的70%（P<.001）。仅手术中断就占总差异的45%。通过间接测热法确定的估计能量需求与平均摄入能量没有差异。
大多数接受机械通气且接受肠内喂养的重症患者未达到其能量需求，主要原因是肠内喂养频繁中断。
