Gungabissoon Usha, Hacquoil Kimberley, Bains Chanchal, Irizarry Michael, Dukes George, Williamson Russell, Deane Adam M, Heyland Daren K
Worldwide Epidemiology, Quantitative Sciences, GlaxoSmithKline R&D, Uxbridge, United Kingdom.
Discovery Biometrics, Quantitative Sciences, GlaxoSmithKline R&D, Uxbridge, United Kingdom.
JPEN J Parenter Enteral Nutr. 2015 May;39(4):441-8. doi: 10.1177/0148607114526450. Epub 2014 Mar 17.
We aimed to determine the incidence of enteral feed intolerance and factors associated with intolerance and to assess the influence of intolerance on nutrition and clinical outcomes.
We conducted a retrospective analysis of data from an international observational cohort study of nutrition practices among 167 intensive care units (ICUs). Data were collected on nutrition adequacy, ventilator-free days (VFDs), ICU stay, and 60-day mortality. Intolerance was defined as interruption of enteral nutrition (EN) due to gastrointestinal (GI) reasons (large gastric residuals, abdominal distension, emesis, diarrhea, or subjective discomfort). Logistic regression was used to determine risk factors for intolerance and their clinical significance. A sensitivity analysis restricted to sites specifying a gastric residual volume ≥200 mL to identify intolerance was also conducted.
Data from 1,888 ICU patients were included. The incidence of intolerance was 30.5% and occurred after a median 3 days from EN initiation. Patients remained intolerant for a mean (±SD) duration of 1.9 ± 1.3 days . Intolerance was associated with worse nutrition adequacy vs the tolerant (56% vs 64%, P < .0001), fewer VFDs (2.5 vs 11.2, P < .0001), increased ICU stay (14.4 vs 11.3 days, P < .0001), and increased mortality (30.8% vs 26.2, P = .04). The sensitivity analysis demonstrated that intolerance remained associated with negative outcomes. Although mortality was greater among the intolerant patients, this was not statistically significant.
Intolerance occurs frequently during EN in critically ill patients and is associated with poorer nutrition and clinical outcomes.
我们旨在确定肠内营养不耐受的发生率及其相关因素，并评估不耐受对营养和临床结局的影响。
我们对一项针对167个重症监护病房（ICU）营养实践的国际观察性队列研究的数据进行了回顾性分析。收集了营养充足情况、无呼吸机天数（VFD）、ICU住院时间和60天死亡率的数据。不耐受被定义为因胃肠道（GI）原因（胃残余量过大、腹胀、呕吐、腹泻或主观不适）导致肠内营养（EN）中断。采用逻辑回归确定不耐受的危险因素及其临床意义。还进行了一项敏感性分析，仅限于指定胃残余量≥200 mL以确定不耐受的研究地点。
纳入了1888例ICU患者的数据。不耐受的发生率为30.5%，在开始EN后的中位3天发生。患者不耐受的平均（±标准差）持续时间为1.9±1.3天。与耐受患者相比，不耐受与营养充足情况较差（56%对64%，P<.0001）、VFD较少（2.5对11.2，P<.0001）、ICU住院时间延长（14.4对11.3天，P<.0001）以及死亡率增加（30.8%对26.2，P=.04）相关。敏感性分析表明，不耐受仍然与不良结局相关。虽然不耐受患者的死亡率更高，但这在统计学上并不显著。
危重症患者在肠内营养期间频繁发生不耐受，且与营养状况较差和临床结局相关。
