Division of Critical Care, Department of Anesthesia, Department of Nursing, Division of Gastroenterology, and Nutrition and Clinical Research Program, Biostatistics Core, at Children's Hospital Boston, Boston, Massachusetts 02115, USA.
JPEN J Parenter Enteral Nutr. 2010 Jan-Feb;34(1):38-45. doi: 10.1177/0148607109348065. Epub 2009 Nov 10.
To describe nutrient intake in critically ill children, identify risk factors associated with avoidable interruptions to enteral nutrition (EN), and highlight opportunities to improve enteral nutrient delivery in a busy tertiary pediatric intensive care unit (PICU). Design, Setting, and Measurements: Daily nutrient intake and factors responsible for avoidable interruptions to EN were recorded in patients admitted to a 29-bed medical and surgical PICU over 4 weeks. Clinical characteristics, time to reach caloric goal, and parenteral nutrition (PN) use were compared between patients with and without avoidable interruptions to EN.
Daily record of nutrient intake was obtained in 117 consecutive patients (median age, 7 years). Eighty (68%) patients received EN (20% postpyloric) for a total of 381 EN days (median, 2 days). Median time to EN initiation was less than 1 day. However, EN was subsequently interrupted in 24 (30%) patients at an average of 3.7 +/- 3.1 times per patient (range, 1-13), for a total of 88 episodes accounting for 1,483 hours of EN deprivation in this cohort. Of the 88 episodes of EN interruption, 51 (58%) were deemed as avoidable. Mechanically ventilated subjects were at the highest risk of EN interruptions. Avoidable EN interruption was associated with increased reliance on PN and impaired ability to reach caloric goal.
EN interruption is common and frequently avoidable in critically ill children. Knowledge of existing barriers to EN such as those identified in this study will allow appropriate interventions to optimize nutrition provision in the PICU.
描述危重症患儿的营养摄入情况，确定与肠内营养（EN）可避免中断相关的风险因素，并强调在繁忙的三级儿科重症监护病房（PICU）中改善肠内营养物质输送的机会。
设计、设置和测量：在四周内，对入住 29 张病床的内科和外科 PICU 的患者，记录每日营养摄入和导致 EN 可避免中断的因素。比较有和无 EN 可避免中断的患者的临床特征、达到热量目标的时间和肠外营养（PN）的使用情况。
连续 117 例患者（中位年龄 7 岁）获得了营养摄入的每日记录。80 例（20%为幽门后）患者接受了总计 381 天的 EN（中位数为 2 天）。EN 启动时间中位数不到 1 天。然而，24 例（30%）患者的 EN 随后被中断，平均每个患者中断 3.7+/-3.1 次（范围为 1-13），在该队列中总共导致 88 次 EN 剥夺，持续 1483 小时。在 88 次 EN 中断中，51 次（58%）被认为是可避免的。接受机械通气的患者发生 EN 中断的风险最高。可避免的 EN 中断与对 PN 的依赖增加和达到热量目标的能力受损有关。
EN 中断在危重症儿童中很常见，且常常是可以避免的。了解 EN 存在的障碍（如本研究中确定的障碍）将有助于采取适当的干预措施，优化 PICU 中的营养供给。
