Department of Medicine, Queen's University, Kingston, Ontario, Canada.
JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34(6):675-84. doi: 10.1177/0148607110364843.
To evaluate the effect of enteral feeding protocols on key indicators of enteral nutrition in the critical care setting.
International, prospective, observational, cohort studies conducted in 2007 and 2008 in 269 intensive care units (ICUs) in 28 countries were combined for the purposes of this analysis. The study included 5497 consecutively enrolled, mechanically ventilated, adult patients who stayed in the ICU for at least 3 days. Sites recorded the presence or absence of a feeding protocol operational in their ICU. They provided selected nutritional data on enrolled patients from ICU admission to ICU discharge for a maximum of 12 days. Sites that used a feeding protocol were compared with those that did not.
On average, protocolized sites used more enteral nutrition (EN) alone (70.4% of patients vs 63.6%, P = .0036), started EN earlier (41.2 hours from admission to ICU vs 57.1, P = .0003), and used more motility agents in patients with high gastric residual volumes (64.3% of patients vs 49.0%, P = .0028) compared with sites that did not use a feeding protocol. Overall nutritional adequacy (61.2% of patients' caloric requirements vs 51.7%, P = .0003) and adequacy from EN were higher in protocolized sites compared with nonprotocolized sites (45.4% of requirements vs 34.7%, P < .0001). EN adequacy remained significantly higher after adjustment for pertinent patient and ICU level baseline characteristics.
The presence of an enteral feeding protocol is associated with significant improvements in nutrition practice compared with sites that do not use such a protocol.
评估肠内喂养方案对重症监护环境中肠内营养关键指标的影响。
本分析纳入了 2007 年和 2008 年在 28 个国家的 269 个重症监护病房（ICU）进行的国际、前瞻性、观察性、队列研究。该研究纳入了 5497 例连续入组的、机械通气的、入住 ICU 至少 3 天的成年患者。各研究点记录 ICU 中是否存在喂养方案。从 ICU 入院至 ICU 出院，各研究点为纳入患者提供了最多 12 天的特定营养数据。将使用喂养方案的研究点与未使用喂养方案的研究点进行了比较。
与未使用喂养方案的研究点相比，使用喂养方案的研究点肠内营养（EN）的使用率更高（70.4%的患者 vs 63.6%，P =.0036）、EN 起始时间更早（ICU 入院后 41.2 小时 vs 57.1 小时，P =.0003）、高胃残留量患者中使用动力药物的比例更高（64.3%的患者 vs 49.0%，P =.0028）。与未使用喂养方案的研究点相比，使用喂养方案的研究点整体营养充足率（61.2%的患者热量需求 vs 51.7%，P =.0003）和 EN 充足率（45.4%的需求 vs 34.7%，P <.0001）更高。在调整相关患者和 ICU 基线特征后，EN 充足率仍显著升高。
与未使用喂养方案的研究点相比，使用肠内喂养方案与营养实践的显著改善相关。
