Department of Nutrition and Dietetics, Severance Hospital, Yonsei University Health System, Seoul, Korea.
J Korean Med Sci. 2013 Jul;28(7):1055-9. doi: 10.3346/jkms.2013.28.7.1055. Epub 2013 Jul 3.
To evaluate the incidence of delayed enteral nutrition (EN) and identify avoidable causes of delay, we retrospectively reviewed medical records of 200 children (median age [range]; 37.5 [1-216] months) who stayed in the intensive care unit (ICU) for a minimum of 3 days. Among 200 children, 115 received EN following ICU admission with a median time of EN initiation of 5 days after admission. Of these, only 22 patients achieved the estimated energy requirement. A significant decrease in the final z score of weight for age from the initial assessment was observed in the non-EN group only (-1.3±2.17 to -1.57±2.35, P<0.001). More survivors than non-survivors received EN during their ICU stay (61.2% vs 30.0%, P=0.001) and received EN within 72 hr of ICU admission (19.8% vs 3.3%, P=0.033). The most common reason for delayed EN was gastrointestinal (GI) bleeding, followed by altered GI motility and hemodynamic instability. Only eight cases of GI bleeding and one case of altered GI motility were diagnosed as active GI bleeding and ileus, respectively. This study showed that the strategies to reduce avoidable withholding EN are necessary to improve the nutrition status of critically ill children.
为了评估延迟肠内营养（EN）的发生率并确定延迟的可避免原因，我们回顾性地审查了在重症监护病房（ICU）至少停留 3 天的 200 名儿童（中位数年龄[范围]；37.5 [1-216] 个月）的病历。在 200 名儿童中，有 115 名在入住 ICU 后接受了 EN，EN 开始的中位数时间为入院后 5 天。在这些患者中，只有 22 名患者达到了估计的能量需求。仅在未接受 EN 组中观察到初始评估时体重与年龄的最终 z 评分显著下降（-1.3±2.17 至-1.57±2.35，P<0.001）。在 ICU 期间，更多的幸存者接受了 EN（61.2% vs 30.0%，P=0.001），并且在 ICU 入院后 72 小时内接受了 EN（19.8% vs 3.3%，P=0.033）。延迟 EN 的最常见原因是胃肠道（GI）出血，其次是 GI 动力改变和血流动力学不稳定。仅 8 例 GI 出血和 1 例 GI 动力改变分别被诊断为活动性 GI 出血和肠梗阻。本研究表明，需要采取策略来减少可避免的停止 EN，以改善危重症儿童的营养状况。
