Moses Viju, Mahendri Narayani V, John George, Peter John Victor, Ganesh Alka
Department of Medicine, Christian Medical College and Hospital, Vellore, TN, India.
Clin Toxicol (Phila). 2009 May;47(5):419-24. doi: 10.1080/15563650902936664.
Early institution of enteral feeds may be associated with improved outcomes in the critically ill. This study evaluated the effect of hypocaloric enteral nutritional supplementation in acute organophosphate(OP)-poisoned patients requiring invasive mechanical ventilation.
Prospective randomized controlled trial conducted in the medical intensive care unit (ICU) of a tertiary care university teaching hospital.
During a 13-month period, 87 OP-poisoned patients were admitted. Twenty-seven patients who were not ventilated were excluded. Thirty patients were randomized to the control arm and 29 to the intervention arm. The intervention arm received hypocaloric nasogastric feeds within 48 h of intubation whilst the control arm received intravenous fluids. Primary outcome was infectious complications. Secondary outcomes included hospital mortality, duration of ventilation, ICU stay, and hospital stay.
An infectious complication occurred in 14 patients (48%) in the intervention group and 15 patients (50%) in the control group (p = 0.898). Three patients in each group died (p = 0.965). Duration of ventilation (p = 0.19) and ICU stay (p = 0.41) were similar. Duration of hospital stay was shorter in the control group (p = 0.05). Gastric stasis occurred in two patients (6.9%) receiving enteral feeds. Feeding related complications were less frequent than in other published trials.
In OP-poisoned patients, early hypocaloric enteral feeding was not associated with improvements in clinical endpoints, albeit longer hospital stay was observed in the enterally fed group. Feeding related complications were infrequent. Further studies would help define the status of early enteral feeding in this subset of patients.
早期给予肠内营养可能与危重症患者预后改善相关。本研究评估了低热量肠内营养补充对需要有创机械通气的急性有机磷（OP）中毒患者的影响。
在一所三级大学教学医院的医学重症监护病房（ICU）进行的前瞻性随机对照试验。
在13个月期间，收治了87例OP中毒患者。排除27例未进行通气的患者。30例患者被随机分配至对照组，29例患者被随机分配至干预组。干预组在插管后48小时内接受低热量鼻饲，而对照组接受静脉输液。主要结局为感染性并发症。次要结局包括医院死亡率、通气时间、ICU住院时间和住院时间。
干预组14例患者（48%）发生感染性并发症，对照组15例患者（50%）发生感染性并发症（p = 0.898）。每组各有3例患者死亡（p = 0.965）。通气时间（p = 0.19）和ICU住院时间（p = 0.41）相似。对照组的住院时间较短（p = 0.05）。接受肠内营养的2例患者（6.9%）出现胃潴留。与喂养相关的并发症比其他已发表的试验更少。
在OP中毒患者中，早期低热量肠内喂养与临床结局改善无关，尽管肠内营养组的住院时间更长。与喂养相关的并发症并不常见。进一步的研究将有助于明确这部分患者早期肠内喂养的情况。
