Patel Jayshil J, Kozeniecki Michelle, Biesboer Annie, Peppard William, Ray Ananda S, Thomas Seth, Jacobs Elizabeth R, Nanchal Rahul, Kumar Gagan
Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
Department of Nutrition Services, Medical College of Wisconsin, Milwaukee, WI, USA.
J Intensive Care Med. 2016 Aug;31(7):471-7. doi: 10.1177/0885066614554887. Epub 2014 Oct 14.
Current guidelines provide weak recommendations for starting enteral nutrition (EN) in patients with septic shock (on vasopressor support). Outcomes of patients receiving EN in septic shock on vasopressor support have not been well studied. We hypothesize that early trophic EN in mechanically ventilated patients with septic shock is associated with improved outcomes.
Single-center retrospective study of mechanically ventilated patients admitted with septic shock to identify patients receiving (1) no EN, (2) <600 kcal/d within 48 hours, and (3) ≥600 kcal/d within 48 hours. Outcomes studied included in-hospital mortality, length of intensive care unit stay (LOS), duration of mechanical ventilation (DOMV), and complications of feeding intolerance.
Sixty-six patients were identified. In all, 15 received no EN, 37 received <600 kcal/d, and 14 received ≥600 kcal/d EN daily. Median LOS was 12, 5, and 13 days, respectively. The LOS was lower in patients receiving <600 kcal/d when compared to either no EN (P < .001) or those receiving ≥600 kcal/d (P < .001). Median DOMV was lower in patients receiving <600 kcal/d (median 3, P < .001) as compared to no EN (median 7, P < .001) or those receiving ≥600 kcal/d (median 7.5, P < .001). Mortality was not different. There were no significant complications among groups.
In patients with septic shock, those receiving <600 kcal/d EN within 48 hours had lower DOMV and LOS when compared to those who did not receive EN or those who received ≥600 kcal/d. These observations provide strong justification for prospective evaluation of the effect of early trophic EN in patients with septic shock.
当前指南对感染性休克（接受血管活性药物支持）患者开始肠内营养（EN）的推荐力度较弱。在接受血管活性药物支持的感染性休克患者中，接受肠内营养的患者的结局尚未得到充分研究。我们假设，对于机械通气的感染性休克患者，早期给予营养性肠内营养与改善结局相关。
对因感染性休克入院的机械通气患者进行单中心回顾性研究，以确定接受以下情况的患者：（1）未接受肠内营养；（2）48小时内能量摄入<600千卡/天；（3）48小时内能量摄入≥600千卡/天。研究的结局包括住院死亡率、重症监护病房住院时间（LOS）、机械通气时间（DOMV）以及喂养不耐受并发症。
共纳入66例患者。其中，15例未接受肠内营养，37例能量摄入<600千卡/天，14例能量摄入≥600千卡/天。中位住院时间分别为12天、5天和13天。与未接受肠内营养的患者（P < .001）或能量摄入≥600千卡/天的患者（P < .001）相比，能量摄入<600千卡/天的患者住院时间更短。与未接受肠内营养的患者（中位时间7天，P < .001）或能量摄入≥600千卡/天的患者（中位时间7.5天，P < .001）相比，能量摄入<600千卡/天的患者中位机械通气时间更短（中位时间3天，P < .001）。死亡率无差异。各组间均无显著并发症发生。
在感染性休克患者中，与未接受肠内营养或能量摄入≥600千卡/天的患者相比，在48小时内接受能量摄入<600千卡/天肠内营养的患者机械通气时间和住院时间更短。这些观察结果为前瞻性评估早期营养性肠内营养对感染性休克患者的影响提供了有力依据。
