Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
JPEN J Parenter Enteral Nutr. 2010 May-Jun;34(3):280-8. doi: 10.1177/0148607109353439.
The objective of this study was to determine whether caloric intake independently influences mortality and morbidity of critically ill patients.
The study was conducted as a nested cohort study within a randomized controlled trial in a tertiary care intensive care unit (ICU). The main exposure in the study was average caloric intake/target for the first 7 ICU days. The primary outcomes were ICU and hospital mortality. Secondary outcomes included ICU-acquired infections, ventilator-associated pneumonia (VAP), duration of mechanical ventilation days, and ICU and hospital length of stay (LOS). The authors divided patients (n = 523) into 3 tertiles according to the percentage of caloric intake/target: tertile I <33.4%, tertile II 33.4%-64.6%, and tertile III >64.6%. To adjust for potentially confounding variables, the authors assessed the association between caloric intake/target and the different outcomes using multivariate logistic regression for categorical outcomes (tertile I was used as reference) and multiple linear regression for continuous outcomes.
Tertile III was associated with higher adjusted hospital mortality, higher risk of ICU-acquired infections, and a trend toward higher VAP rate. Increasing caloric intake was independently associated with a significant increase in duration of mechanical ventilation, ICU LOS, and hospital LOS.
The data demonstrate that near-target caloric intake is associated with significantly increased hospital mortality, ICU-acquired infections, mechanical ventilation duration, and ICU and hospital LOS. Further studies are needed to explore whether reducing caloric intake would improve the outcomes in critically ill patients.
本研究旨在确定热量摄入是否会独立影响危重症患者的死亡率和发病率。
该研究是在一家三级护理重症监护病房（ICU）的随机对照试验中进行的嵌套队列研究。研究中的主要暴露因素是前 7 天 ICU 内的平均热量摄入/目标摄入量。主要结局为 ICU 内和医院内死亡率。次要结局包括 ICU 获得性感染、呼吸机相关性肺炎（VAP）、机械通气天数、ICU 和医院住院时间（LOS）。作者根据热量摄入/目标的百分比将患者（n=523）分为 3 个三分位组：三分位 I<33.4%、三分位 II 33.4%-64.6%和三分位 III >64.6%。为了调整潜在的混杂变量，作者使用多变量逻辑回归分析分类结局（三分位 I 用作参考）和多元线性回归分析连续结局，评估热量摄入/目标与不同结局之间的关联。
三分位 III 与调整后较高的医院死亡率、较高的 ICU 获得性感染风险以及 VAP 发生率较高相关。热量摄入增加与机械通气时间、ICU LOS 和医院 LOS 的显著增加独立相关。
数据表明，接近目标的热量摄入与显著增加的医院死亡率、ICU 获得性感染、机械通气时间以及 ICU 和医院 LOS 相关。需要进一步研究以探讨减少热量摄入是否会改善危重症患者的结局。
