Kuslapuu Maarja, Jõgela Krista, Starkopf Joel, Reintam Blaser Annika
General Intensive Care Unit, Tartu University Hospital, Tartu, Estonia.
General Intensive Care Unit, Tartu University Hospital, Tartu, Estonia; Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
Intensive Crit Care Nurs. 2015 Oct;31(5):309-14. doi: 10.1016/j.iccn.2015.03.001. Epub 2015 Apr 10.
Although enteral nutrition (EN) in critically ill patients is increasingly common, enteral underfeeding remains problematic. In the present study, we aimed to identify the reasons for insufficient EN.
In this single-centre, prospective, observational study in a general intensive care unit, the nurses documented cases experiencing enteral underfeeding during three-month study period. Decisions regarding EN were made and substantiated by the doctors. No feeding protocol was in use. The EN rate was assessed daily and considered insufficient if less than 50 kcal/h was administered and the rate had not increase in the previous 12 hour period.
Eighty-seven patients were screened for 707 patient-days. Nurses documented 141 instances of insufficient EN in 49 patients (56.7% of all study subjects). EN was not initiated in 61% of these cases, EN was stopped in 14%, EN decreased in 2% and insufficient EN was not increased in 23%. EN was not initiated primarily due to surgical reasons. EN was not increased due to clinical instability. EN was decreased or stopped primarily due to high gastric residual volumes (GRV). The study served as step one in a quality improvement process and resulted in the introduction of a nurse-driven feeding protocol.
The main reasons for insufficient EN in intensive care patients include recent GI surgery, shock and large GRV. EN is commonly withheld for several days after GI surgery, whereas in shock there was a prohibition on increasing EN towards the target. Insufficient EN is highly prevalent; the incidence of EN should be reduced by training and the acceptance of more liberal EN policies.
尽管重症患者的肠内营养（EN）越来越普遍，但肠内营养摄入不足仍然是个问题。在本研究中，我们旨在确定肠内营养不足的原因。
在一家综合重症监护病房进行的这项单中心、前瞻性观察研究中，护士记录了为期三个月的研究期间肠内营养摄入不足的病例。关于肠内营养的决策由医生做出并提供依据。未使用喂养方案。每天评估肠内营养输注速率，如果每小时输注量少于50千卡且在之前12小时内速率未增加，则认为营养摄入不足。
对87例患者进行了707个患者日的筛查。护士记录了49例患者（占所有研究对象的56.7%）出现141次肠内营养不足的情况。其中61%的病例未开始肠内营养，14%的病例肠内营养被停止，2%的病例肠内营养减少，23%的病例肠内营养不足未得到改善。未开始肠内营养主要是由于手术原因。由于临床不稳定，肠内营养未增加。肠内营养减少或停止主要是由于胃残余量（GRV）过高。该研究是质量改进过程的第一步，并导致引入了由护士主导的喂养方案。
重症监护患者肠内营养不足的主要原因包括近期胃肠道手术、休克和胃残余量过大。胃肠道手术后通常会几天不进行肠内营养，而在休克状态下则禁止将肠内营养增加至目标量。肠内营养不足非常普遍；应通过培训和接受更宽松的肠内营养政策来降低肠内营养不足的发生率。
