Higgins Patricia A, Daly Barbara J, Lipson Amy R, Guo Su-Er
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
Am J Crit Care. 2006 Mar;15(2):166-76; quiz 177.
Numerous methods are used to measure and assess nutritional status of chronically critically ill patients.
To discuss the multiple methods used to assess nutritional status in chronically critically ill patients, describe the nutritional status of chronically critically ill patients, and assess the relationship between nutritional indicators and outcomes of mechanical ventilation.
A descriptive, longitudinal design was used to collect weekly data on 360 adult patients who required more than 72 hours of mechanical ventilation and had a hospital stay of 7 days or more. Data on body mass index and biochemical markers of nutritional status were collected. Patients' nutritional intake compared with physicians' orders, dieticians' recommendations, and indirect calorimetry and physicians' orders compared with dieticians' recommendations were used to assess nutritional status. Relationships between nutritional indicators and variables of mechanical ventilation were determined.
Inconsistencies among nurses' implementation, physicians' orders, and dieticians' recommendations resulted in wide variations in patients' calculated nutritional adequacy. Patients received a mean of 83% of the energy intake ordered by their physicians (SD 33%, range 0%-200%). Patients who required partial or total ventilator support upon discharge had a lower body mass index at admission than did patients with spontaneous respirations (Mann-Whitney U = 8441, P = .001).
In this sample, the variability in weaning progression and outcomes most likely reflects illness severity and complexity rather than nutritional status or nutritional therapies. Further studies are needed to determine the best methods to define nutritional adequacy and to evaluate nutritional status.
有多种方法用于测量和评估慢性危重症患者的营养状况。
探讨用于评估慢性危重症患者营养状况的多种方法，描述慢性危重症患者的营养状况，并评估营养指标与机械通气结局之间的关系。
采用描述性纵向设计，每周收集360例成年患者的数据，这些患者需要机械通气超过72小时且住院时间为7天或更长时间。收集体重指数和营养状况生化标志物的数据。将患者的营养摄入量与医生的医嘱、营养师的建议以及间接测热法进行比较，并将医生的医嘱与营养师的建议进行比较，以评估营养状况。确定营养指标与机械通气变量之间的关系。
护士的实施、医生的医嘱和营养师的建议之间存在不一致，导致患者计算出的营养充足率差异很大。患者平均摄入的能量为医生医嘱的83%（标准差33%，范围0%-200%）。出院时需要部分或全部呼吸机支持的患者入院时的体重指数低于自主呼吸的患者（曼-惠特尼U = 8441，P = 0.001）。
在本样本中，脱机进展和结局的变异性最有可能反映疾病的严重程度和复杂性，而非营养状况或营养治疗。需要进一步研究以确定定义营养充足和评估营养状况的最佳方法。
