评估危重症患者的营养支持及其与呼吸重症监护病房结局的相关性。

An assessment of nutritional support to critically ill patients and its correlation with outcomes in a respiratory intensive care unit.

机构信息

Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.

出版信息

Respir Care. 2009 Dec;54(12):1688-96.

PMID:19961635

Abstract

BACKGROUND

Nutritional support is frequently neglected in a busy intensive care unit (ICU) with overworked staff. There is a paucity of investigations on ICU nutrition from India.

OBJECTIVES

To assess the adequacy of nutritional support administered to patients requiring mechanical ventilation in the respiratory ICU of a tertiary-care institute, and its correlation with outcomes.

METHODS

This was a prospective cohort study of patients >or= 15 years old who underwent mechanical ventilation for at least 24 hours and had a respiratory ICU stay of at least 48 hours. Enteral nutritional support was initiated as early as possible after respiratory ICU admission. The daily calorie and protein prescription was 30 kcal/kg and 1.2 g/kg ideal body weight, respectively, with appropriate adjustments for critical illness(es) and comorbidities. Anthropometric and laboratory parameters were assessed serially. Risk factors for hospital mortality were evaluated using multivariable logistic regression analysis.

RESULTS

During the study period, 258 patients were admitted to the respiratory ICU, of whom 93, who fulfilled all the inclusion criteria, composed the study population. Calorie prescription increased from a median and interquartile range (IQR) of 88.9% (80.4-99.0%) of the recommended value on day 1 to 114.4% (99.9-122.5%) on day 21. Protein prescription improved from 80.1% (67.1-90.6%) of the recommended value on day 1 to 98.4% (76.1-120.8%) on day 28. Calorie delivery increased from 55.1% (35.4-81.3%) of the recommended value on day 1 to 92.0% (35.7-124.6%) on day 28. Protein delivery improved from 46.7% (31.6-72.1%) of the recommended value on day 1 to 75.3% (54.3-85.5%) on day 28. Risk factors for hospital mortality identified were admission Sequential Organ-Failure Assessment score (odds ratio 1.30, 95% confidence interval 1.03-1.63) and mean daily calorie delivery of <or= 50% of the recommended value (odds ratio 12.08, 95% confidence interval 1.40-104.11).

CONCLUSIONS

Calorie and protein delivery to critically ill patients remains less than the recommended values. Inadequate calorie delivery is associated with higher odds of mortality.

摘要

背景

在忙碌的重症监护病房（ICU）中，工作人员过度劳累，营养支持常常被忽视。印度对 ICU 营养的研究很少。

目的

评估在三级医疗机构的呼吸 ICU 中需要机械通气的患者接受的营养支持的充足性，并评估其与结果的相关性。

方法

这是一项对≥15 岁的患者进行的前瞻性队列研究，这些患者接受了至少 24 小时的机械通气，并且在呼吸 ICU 的住院时间至少为 48 小时。在呼吸 ICU 入院后尽早开始肠内营养支持。每日热量和蛋白质处方分别为 30kcal/kg 和 1.2g/kg 理想体重，根据危重病和合并症进行适当调整。连续评估人体测量和实验室参数。使用多变量逻辑回归分析评估医院死亡率的危险因素。

结果

在研究期间，有 258 名患者入住呼吸 ICU，其中符合所有纳入标准的 93 名患者组成了研究人群。热量处方从第 1 天的中位数和四分位距（IQR）为推荐值的 88.9%（80.4-99.0%）增加到第 21 天的 114.4%（99.9-122.5%）。蛋白质处方从第 1 天的推荐值的 80.1%（67.1-90.6%）提高到第 28 天的 98.4%（76.1-120.8%）。热量供应从第 1 天的推荐值的 55.1%（35.4-81.3%）增加到第 28 天的 92.0%（35.7-124.6%）。蛋白质供应从第 1 天的推荐值的 46.7%（31.6-72.1%）提高到第 28 天的 75.3%（54.3-85.5%）。确定的医院死亡率危险因素为入院序贯器官衰竭评估评分（比值比 1.30，95%置信区间 1.03-1.63）和每日平均热量供应<或=推荐值的 50%（比值比 12.08，95%置信区间 1.40-104.11）。