1Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada. 2Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada. 3Nutrition Services Alberta Health Services, Stollery Children's Hospital, Edmonton, AB, Canada.
Pediatr Crit Care Med. 2014 Feb;15(2):e49-55. doi: 10.1097/PCC.0000000000000016.
Clinicians believe nutrition support is important; however, delivery of enteral nutrition may be delayed or interrupted due to a lack of guidelines or perceived contraindications to administration. The aim of this national survey was to examine the knowledge and perceived barriers among clinicians which prevent enteral nutrition administration to PICU patients.
The survey consisted of 23 questions (19 primary and four branching). The survey was validated using a semistructured pilot test by three pediatric critical care intensivists and two pediatric critical care registered dietitians external to the study team.
The survey was electronically distributed to clinicians in all PICUs across Canada.
One hundred sixty-two PICU clinicians, including 96 staff intensivists, eight clinical assistants, 36 fellows, and 22 registered dietitians from PICUs across Canada.
None.
The survey was administered from January to March 2013. The response rate was 50% (55 staff intensivists, two clinical assistants, nine fellows, and 15 registered dietitians). There was high variability among clinicians regarding reasons to delay the onset of enteral nutrition or interrupt enteral nutrition administration. High variability (> 70% agreement and < 10% disagreement or vice versa) was found for some reasons to delay or interrupt enteral nutrition, including lactates (rising or > 2 or > 4 mmol/L), high gastric residual volumes, CT/MRI scans, and hypoplastic left heart syndrome. Sixty-eight percent of PICU clinicians reported no written feeding protocol to be in place.
Overall, there is high variability among clinicians regarding acceptable procedural and clinical barriers to enteral nutrition administration; this may be improved by a standardized feeding protocol. Therefore, further research must be conducted to provide clinicians with evidence to support their practices for enteral nutrition administration.
临床医生认为营养支持很重要；然而，由于缺乏指南或认为存在给药禁忌，肠内营养的实施可能会延迟或中断。本项全国性调查旨在研究临床医生的知识和阻碍肠内营养给予 ICU 患儿的认知障碍。
调查问卷包括 23 个问题（19 个主要问题和 4 个分支问题）。该调查通过三位儿科重症监护医师和两位外部儿科重症监护营养师的半结构化预试验进行了验证。
通过电子方式向加拿大所有儿科 ICU 的临床医生分发调查问卷。
来自加拿大各地儿科 ICU 的 162 名儿科 ICU 临床医生，包括 96 名主治医生、8 名临床助理医生、36 名研究员和 22 名营养师。
无。
调查于 2013 年 1 月至 3 月进行。应答率为 50%（55 名主治医生、2 名临床助理医生、9 名研究员和 15 名营养师）。在延迟肠内营养开始或中断肠内营养实施的原因方面，临床医生之间存在很大的差异。在延迟或中断肠内营养的一些原因上，存在很大的差异（>70%的医生意见一致，<10%的医生意见不一致或反之亦然），包括乳酸性（升高或>2 或>4mmol/L）、胃残留量高、CT/MRI 扫描和左心发育不全。68%的儿科 ICU 医生报告没有制定书面喂养方案。
总体而言，临床医生在肠内营养实施的可接受程序和临床障碍方面存在很大差异；通过标准化的喂养方案，这一情况可能会得到改善。因此，必须进行进一步的研究，为临床医生提供支持肠内营养管理的证据。
