Elke Gunnar, Schädler Dirk, Engel Christoph, Bogatsch Holger, Frerichs Inez, Ragaller Maximilian, Scholz Jens, Brunkhorst Frank M, Löffler Markus, Reinhart Konrad, Weiler Norbert
Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Germany.
Crit Care Med. 2008 Jun;36(6):1762-7. doi: 10.1097/CCM.0b013e318174dcf0.
To identify current clinical practice regarding nutrition and its association with morbidity and mortality in patients with severe sepsis or septic shock in Germany.
Nationwide prospective, observational, cross-sectional, 1-day point-prevalence study.
The study included 454 intensive care units from a representative sample of 310 hospitals stratified by size.
Participants were 415 patients with severe sepsis or septic shock (according to criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference).
None.
Data were collected by on-site audits of trained external study physicians during randomly scheduled visits during 1 yr. Valid data on nutrition were available for 399 of 415 patients. The data showed that 20.1% of patients received exclusively enteral nutrition, 35.1% exclusively parenteral nutrition, and 34.6% mixed nutrition (parenteral and enteral); 10.3% were not fed at all. Patients with gastrointestinal/intra-abdominal infection, pancreatitis or neoplasm of the gastrointestinal tract, mechanical ventilation, or septic shock were less likely to receive exclusively enteral nutrition. Median Acute Physiology and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment scores were significantly different among the nutrition groups. Overall hospital mortality was 55.2%. Hospital mortality was significantly higher in patients receiving exclusively parenteral (62.3%) or mixed nutrition (57.1%) than in patients with exclusively enteral nutrition (38.9%) (p = .005). After adjustment for patient morbidity (Acute Physiology and Chronic Health Evaluation II score, presence of septic shock) and treatment factors (mechanical ventilation), multivariate analysis revealed that the presence of parenteral nutrition was significantly predictive of mortality (odds ratio, 2.09; 95% confidence interval, 1.29-3.37).
Patients with severe sepsis or septic shock in German intensive care units received preferentially parenteral or mixed nutrition. The use of parenteral nutrition was associated with an increased risk of death.
确定德国严重脓毒症或脓毒性休克患者目前在营养方面的临床实践及其与发病率和死亡率的关联。
全国性前瞻性观察性横断面1日现患率研究。
该研究纳入了来自310家按规模分层的医院的454个重症监护病房的代表性样本。
参与者为415例严重脓毒症或脓毒性休克患者（根据美国胸科医师学会/危重病医学会共识会议的标准）。
无。
数据由经过培训的外部研究医师在1年中随机安排的访视期间通过现场审核收集。415例患者中有399例获得了有效的营养数据。数据显示，20.1%的患者仅接受肠内营养，35.1%仅接受肠外营养，34.6%接受混合营养（肠外和肠内）；10.3%根本未接受喂养。患有胃肠道/腹腔内感染、胰腺炎或胃肠道肿瘤、机械通气或脓毒性休克的患者接受仅肠内营养的可能性较小。营养组之间急性生理与慢性健康状况评分系统II（APACHE II）和脓毒症相关器官功能衰竭评估（SOFA）评分的中位数有显著差异。总体医院死亡率为55.2%。仅接受肠外营养（62.3%）或混合营养（57.1%）的患者的医院死亡率显著高于仅接受肠内营养的患者（38.9%）（p = 0.005）。在对患者发病率（APACHE II评分、脓毒性休克的存在）和治疗因素（机械通气）进行调整后，多因素分析显示肠外营养的存在是死亡率的显著预测因素（比值比，2.09；95%置信区间，1.29 - 3.37）。
德国重症监护病房中严重脓毒症或脓毒性休克患者优先接受肠外或混合营养。肠外营养的使用与死亡风险增加相关。
