Artinian Vasken, Krayem Hicham, DiGiovine Bruno
Henry Ford Hospital, Division of Pulmonary and Critical Care, 2799 W Grand Blvd, K-17, Detroit, MI 48202, USA.
Chest. 2006 Apr;129(4):960-7. doi: 10.1378/chest.129.4.960.
To determine the impact of early enteral feeding on the outcome of critically ill medical patients.
Retrospective analysis of a prospectively collected large multi-institutional ICU database.
A total of 4,049 patients requiring mechanical ventilation for > 2 days.
Patients were classified according to whether or not they received enteral feeding within 48 h of mechanical ventilation onset. The 2,537 patients (63%) who did receive enteral feeding were labeled as the "early feeding group," and the remaining 1,512 patients (37%) were labeled as the "late feeding group." The overall ICU and hospital mortality were lower in the early feeding group (18.1% vs 21.4%, p = 0.01; and 28.7% vs 33.5%, p = 0.001, respectively). The lower mortality rates in the early feeding group were most evident in the sickest group as defined by quartiles of severity of illness scores. Three separate models were done using each of the different scores (acute physiology and chronic health evaluation II, simplified acute physiology score II, and mortality prediction model at time 0). In all models, early enteral feeding was associated with an approximately 20% decrease in ICU mortality and a 25% decrease in hospital mortality. We also analyzed the data after controlling for confounding by matching for propensity score. In this analysis, early feeding was again associated with decreased ICU and hospital mortality. In all adjusted analysis, early feeding was found to be independently associated with an increased risk of ventilator-associated pneumonia (VAP) developing.
Early feeding significantly reduces ICU and hospital mortality based mainly on improvements in the sickest patients, despite being associated with an increased risk of VAP developing. Routine administration of such therapy in medical patients receiving mechanical ventilation is suggested, especially in patients at high risk of death.
确定早期肠内营养对危重症内科患者预后的影响。
对前瞻性收集的大型多机构重症监护病房（ICU）数据库进行回顾性分析。
总共4049例需要机械通气超过2天的患者。
根据患者在机械通气开始后48小时内是否接受肠内营养进行分类。2537例（63%）接受肠内营养的患者被标记为“早期营养组”，其余1512例患者（37%）被标记为“晚期营养组”。早期营养组的总体ICU死亡率和医院死亡率较低（分别为18.1%对21.4%，p = 0.01；以及28.7%对33.5%，p = 0.001）。早期营养组较低的死亡率在病情最严重的组中最为明显（根据疾病严重程度评分四分位数定义）。使用三种不同的评分（急性生理与慢性健康状况评价II、简化急性生理评分II和0时死亡率预测模型）分别进行了三个独立模型分析。在所有模型中，早期肠内营养与ICU死亡率降低约20%以及医院死亡率降低25%相关。我们还在通过倾向评分匹配控制混杂因素后分析了数据。在此分析中，早期营养再次与ICU和医院死亡率降低相关。在所有校正分析中，发现早期营养与呼吸机相关性肺炎（VAP）发生风险增加独立相关。
尽管早期营养与VAP发生风险增加相关，但主要基于病情最严重患者状况的改善，早期营养显著降低了ICU死亡率和医院死亡率。建议对接受机械通气的内科患者常规给予此类治疗，尤其是对死亡风险高的患者。
