Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Nutr Clin Pract. 2014 Jun;29(3):360-7. doi: 10.1177/0884533614530762. Epub 2014 Apr 16.
Enteral nutrition (EN) delivery is associated with improved outcomes in critically ill patients. We aimed to describe EN practices, including details of algorithms and individual bedside practices, in pediatric intensive care units (PICUs).
Available EN algorithm details from 31 international PICUs were obtained. Daily nutrient intake data from 524 mechanically ventilated patients, 1 month to 18 years old, were prospectively documented, including EN delivery, adjunct therapies, and energy prescription. Practices associated with higher percentage adequacy of EN delivery were determined by regression analysis.
Nine EN algorithms were available. All algorithms defined advancement and EN intolerance; 7 of 9 defined intolerance by gastric residual volume; 3 of 9 recommended nutrition screening and fasting guidelines. Few elements were in agreement with the American Society for Parenteral and Enteral Nutrition and the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition guidelines. Of the 341 patients who received EN exclusively 32.9% received ≥66.6% of prescribed energy on day 7. Percentage adequacy of EN delivered was inversely associated with days to EN initiation (-8.92; P < .001) and hours per EN interruption (-1.65; P = .001) and was not associated with the use of algorithms, promotility agents, or postpyloric feeding.
A minority of PICUs employ EN algorithms; recommendations were variable and not in agreement with national guidelines. Optimal EN delivery was achieved in less than one-third of our cohort. EN adjunct therapies were not associated with increased EN delivery. Studies aimed at promoting early EN and decreasing interruptions may optimize energy delivery in the PICU.
肠内营养（EN）的提供与危重症患者的改善结果相关。我们旨在描述儿科重症监护病房（PICU）中的 EN 实践，包括算法和个体床边实践的细节。
从 31 个国际 PICU 获得了可用的 EN 算法详细信息。前瞻性记录了 524 例机械通气的 1 个月至 18 岁患者的每日营养摄入量数据，包括 EN 提供、辅助治疗和能量处方。通过回归分析确定与更高的 EN 提供百分比充足性相关的实践。
提供了 9 种 EN 算法。所有算法都定义了进展和 EN 不耐受；9 个中的 7 个通过胃残留量定义不耐受；3 个建议进行营养筛查和禁食指南。很少有元素与美国肠外和肠内营养学会和欧洲儿科胃肠病学、肝病学和营养学会的指南一致。在仅接受 EN 的 341 例患者中，有 32.9%在第 7 天接受了≥66.6%的规定能量。EN 提供的百分比充足性与 EN 开始的天数呈反比（-8.92；P<0.001）和每小时 EN 中断时间呈反比（-1.65；P=0.001），与算法、促动力药物或幽门后喂养的使用无关。
少数 PICU 使用 EN 算法；建议各不相同，与国家指南不一致。我们队列中不到三分之一的患者实现了最佳的 EN 提供。EN 辅助治疗与增加 EN 提供无关。旨在促进早期 EN 和减少中断的研究可能会优化 PICU 中的能量提供。
