Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Crit Care Med. 2011 May;39(5):967-74. doi: 10.1097/CCM.0b013e31820a905a.
Enteral nutrition is provided to mechanically ventilated patients who cannot eat normally, yet the amount of support needed is unknown. We conducted this randomized, open-label study to test the hypothesis that initial low-volume (i.e., trophic) enteral nutrition would decrease episodes of gastrointestinal intolerance/complications and improve outcomes as compared to initial full-energy enteral nutrition in patients with acute respiratory failure.
Randomized, open-label study.
A total of 200 patients with acute respiratory failure expected to require mechanical ventilation for at least 72 hrs.
Patients were randomized to receive either initial trophic (10 mL/hr) or full-energy enteral nutrition for the initial 6 days of ventilation.
The primary outcome measure was ventilator-free days to day 28. Baseline characteristics were similar between the 98 patients randomized to trophic and the 102 patients randomized to full-energy nutrition. At enrollment, patients had a mean Acute Physiology and Chronic Health Evaluation II score of 26.9 and a PaO2/FiO2 ratio of 182 and 38% were in shock. Both groups received similar durations of enteral nutrition (5.5 vs. 5.1 days; p = .51). The trophic group received an average of 15.8% ± 11% of goal calories daily through day 6 compared to 74.8% ± 38.5% (p < .001) for the full-energy group. Both groups had a median of 23.0 ventilator-free days (p = .90) and a median of 21.0 intensive-care-unit-free days (p = .64). Mortality to hospital discharge was 22.4% for the trophic group vs. 19.6% for the full-energy group (p = .62). In the first 6 days, the trophic group had trends for less diarrhea (19% vs. 24% of feeding days; p = .08) and significantly fewer episodes of elevated gastric residual volumes (2% vs. 8% of feeding days; p < .001).
Initial trophic enteral nutrition resulted in clinical outcomes in mechanically ventilated patients with acute respiratory failure similar to those of early full-energy enteral nutrition but with fewer episodes of gastrointestinal intolerance.
为不能正常进食的机械通气患者提供肠内营养，但所需的支持量尚不清楚。我们进行了这项随机、开放标签研究，以检验以下假设，即与早期给予全能量肠内营养相比，急性呼吸衰竭患者最初给予低容量（即滋养型）肠内营养可减少胃肠道不耐受/并发症的发作，并改善结局。
随机、开放标签研究。
共 200 例预计需要机械通气至少 72 小时的急性呼吸衰竭患者。
患者被随机分配接受最初的滋养（10ml/h）或全能量肠内营养，持续通气 6 天。
主要结局测量指标为通气至第 28 天的无呼吸机天数。两组患者的基线特征相似，98 例随机接受滋养组和 102 例随机接受全能量营养组的患者急性生理学和慢性健康评估 II 评分平均为 26.9，氧分压/吸入氧分数比值为 182，38%存在休克。两组均接受了相似时间的肠内营养（5.5 天对 5.1 天；p =.51）。滋养组在第 6 天前每天平均接受目标热量的 15.8%±11%，而全能量组为 74.8%±38.5%（p<0.001）。两组患者中位无呼吸机天数均为 23.0 天（p =.90），中位 ICU 无天数均为 21.0 天（p =.64）。滋养组出院时死亡率为 22.4%，全能量组为 19.6%（p =.62）。在最初的 6 天内，滋养组腹泻的发生率呈下降趋势（喂养日的 19%对 24%；p =.08），且胃残留量升高的发生率明显较低（喂养日的 2%对 8%；p<0.001）。
急性呼吸衰竭机械通气患者给予初始滋养型肠内营养的临床结局与早期给予全能量肠内营养相似，但胃肠道不耐受的发作次数更少。
