Santana-Cabrera L, O'Shanahan-Navarro G, García-Martul M, Ramírez Rodríguez A, Sánchez-Palacios M, Hernández-Medina E
Servicio de Medicina Intensiva del Hospital Universitario Insular de Gran Canaria, España.
Nutr Hosp. 2006 Nov-Dec;21(6):661-6.
To assess what are the reasons for discrepancies between the amount of nutrients delivered, prescribed and theoretical requirements, in an intensive care unit.
Prospective cohort study over a 5 months period.
Intensive Care Unit of the Insular University Hospital in Gran Canaria.
Adult patients who were prescribed enteral and or parenteral nutrition for > or = 2 days and we followed them for the first 14 days of nutrition delivery.
The prescribed and the delivered calories were calculated every day, whereas the theoretical requeriments were calculated after the ICU stay, by using the Harris-Benedict formula adjusted with a stress factor. Also the reason for cessation of enteral tube feeding > 1 hour in the days of artificial nutrition were analyzed.
Fifty-nine consecutive patients, receiving nutritional support either enterally or intravenously, and 465 nutrition days analyzed. Nutrition was initiated within 48 hours after ICU admission. Enteral nutrition was the preferential route used. Seventy-nine percent of the mean caloric amount required was prescribed, and 66% was effectively delivered; also 88% of the amount prescribed was delivered. The low ratio of delivered-prescribed calories concerned principally enteral nutrition and was caused by gastrointestinal intolerance. We observe a wide variation in practice patterns among physicians to start, increase, reduce or stop enteral nutrition when symptoms of intolerance appear.
In our ICU exists an important difference between the caloric theoretical requests and the quantity really delivered; this deficit is more clear in the enteral nutrition. The knowledge of this situation allows to take measures directed to optimizing the nutritional support of our patients. Possibly the motivation in the medical and nursery personnel in carrying out nutritional protocols it might be the most effective measurement, which it would be necessary to confirm in later studies.
评估重症监护病房中营养物质输送量、处方量与理论需求量之间存在差异的原因。
为期5个月的前瞻性队列研究。
大加那利岛岛民大学医院重症监护病房。
接受肠内和/或肠外营养治疗≥2天的成年患者，并在营养输送的前14天对其进行跟踪。
每天计算处方热量和输送热量，而理论需求量在重症监护病房住院后使用根据应激因素调整的哈里斯- Benedict公式进行计算。此外，还分析了人工营养期间肠内管饲停止超过1小时的原因。
连续59例接受肠内或静脉营养支持的患者，共分析了465个营养日。营养支持在重症监护病房入院后48小时内开始。肠内营养是优先使用的途径。规定的平均热量需求中有79%被处方，66%得到有效输送；规定量的88%也被输送。输送热量与处方热量的低比例主要与肠内营养有关，原因是胃肠道不耐受。我们观察到医生在出现不耐受症状时开始、增加、减少或停止肠内营养的实践模式存在很大差异。
在我们的重症监护病房，热量的理论需求与实际输送量之间存在重要差异；这种差异在肠内营养中更为明显。了解这种情况有助于采取措施优化对患者的营养支持。可能医疗和护理人员执行营养方案的积极性可能是最有效的措施，这有待在后续研究中证实。
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