Yeh D Dante, Fuentes Eva, Quraishi Sadeq A, Cropano Catrina, Kaafarani Haytham, Lee Jarone, King David R, DeMoya Marc, Fagenholz Peter, Butler Kathryn, Chang Yuchiao, Velmahos George
Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts.
JPEN J Parenter Enteral Nutr. 2016 Jan;40(1):37-44. doi: 10.1177/0148607115585142. Epub 2015 Apr 29.
Macronutrient deficit in the surgical intensive care unit (ICU) is associated with worse in-hospital outcomes. We hypothesized that increased caloric and protein deficit is also associated with a lower likelihood of discharge to home vs transfer to a rehabilitation or skilled nursing facility.
Adult surgical ICU patients receiving >72 hours of enteral nutrition (EN) between March 2012 and May 2014 were included. Patients with absolute contraindications to EN, <72-hour ICU stay, moribund state, EN prior to surgical ICU admission, or previous ICU admission within the same hospital stay were excluded. Subjects were dichotomized by cumulative caloric (<6000 vs ≥ 6000 kcal) and protein deficit (<300 vs ≥ 300 g). Baseline characteristics and outcomes were compared using Wilcoxon rank and χ(2) tests. To test the association of macronutrient deficit with discharge destination (home vs other), we performed a logistic regression analysis, controlling for plausible confounders.
In total, 213 individuals were included. Nineteen percent in the low-caloric deficit group were discharged home compared with 6% in the high-caloric deficit group (P = .02). Age, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II), and initiation of EN were not significantly different between groups. On logistic regression, adjusting for BMI and APACHE II score, the high-caloric and protein-deficit groups were less likely to be discharged home (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.08-0.96; P = .04 and OR, 0.29; 95% CI, 0.0-0.89, P = .03, respectively).
In surgical ICU patients, inadequate macronutrient delivery is associated with lower rates of discharge to home. Improved nutrition delivery may lead to better clinical outcomes after critical illness.
外科重症监护病房（ICU）中大量营养素缺乏与更差的院内结局相关。我们推测热量和蛋白质缺乏增加也与出院回家的可能性较低有关，而不是转至康复机构或专业护理机构。
纳入2012年3月至2014年5月期间接受肠内营养（EN）超过72小时的成年外科ICU患者。排除有EN绝对禁忌症、ICU住院时间<72小时、濒死状态、外科ICU入院前接受EN或在同一住院期间曾入住过ICU的患者。根据累积热量（<6000 vs≥6000千卡）和蛋白质缺乏（<300 vs≥300克）将受试者分为两组。使用Wilcoxon秩和检验及χ²检验比较基线特征和结局。为检验大量营养素缺乏与出院目的地（回家与其他）之间的关联，我们进行了逻辑回归分析，并对可能的混杂因素进行了控制。
共纳入213例个体。低热量缺乏组中有19%出院回家，而高热量缺乏组为6%（P = 0.02）。两组之间的年龄、体重指数（BMI）、急性生理与慢性健康状况评分系统II（APACHE II）以及EN的起始情况无显著差异。在逻辑回归分析中，校正BMI和APACHE II评分后，高热量和蛋白质缺乏组出院回家的可能性较小（优势比[OR]分别为0.28；95%置信区间[CI]，0.08 - 0.96；P = 0.04和OR，0.29；95% CI，0.0 - 0.89，P = 0.03）。
在外科ICU患者中，大量营养素供应不足与出院回家率较低相关。改善营养供应可能会使危重病后的临床结局更好。
