在外科重症监护病房引入促进肠内营养的指南与更早开始肠内喂养相关。

Introduction of guidelines to facilitate enteral nutrition in a surgical intensive care unit is associated with earlier enteral feeding.

作者信息

Zacharias N, Blank R, Bittner E A, Joyce S, Kondili D, Fisher D, Eikermann M, Velmahos G C, Schmidt U

机构信息

Division of Trauma, Emergency Surgery and Surgical Critical Care, Boston, MA, USA.

Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit Street, Boston, MA, 02114, USA.

出版信息

Eur J Trauma Emerg Surg. 2011 Dec;37(6):605-8. doi: 10.1007/s00068-011-0085-6. Epub 2011 Mar 1.

DOI:10.1007/s00068-011-0085-6

PMID:26815472

Abstract

PURPOSE

Patients treated postoperatively in surgical intensive care units often receive delayed enteral nutrition. We hypothesized that the introduction of guidelines promoting early enteral nutrition is associated with earlier enteral feeding.

METHODS

Enteral nutrition guidelines were created by the consensus of a multidisciplinary team consisting of intensivists, nurses, nutritionists, and surgeons. The guidelines were implemented through repeated staff education. We prospectively compared data on nutritional support in the surgical intensive care unit of a tertiary care center before (pre-intervention period, from January 27 to April 30, 2008) and after (post-intervention period, from May 1st to August 15th, 2008) implementation of the guidelines. The primary outcome was time to enteral feeding (oral or tube feeding).

RESULTS

146 patients were evaluated during the pre-period and 141 patients during the post-period. Patients during the two time periods had similar demographics and clinical characteristics. None of the patients were without nutrition for longer than 7 days. Oral or feeding tube nutrition was started earlier in the post-period (median 1 vs. 2 days, p < 0.001). There was no difference in the percentages of patients receiving parenteral nutrition (7.4 vs. 10%, p = 0.360). There was no increase in aspiration events in the post-period (8 vs. 9.4%, p = 0.606).

CONCLUSIONS

Introduction of guidelines to facilitate enteral nutrition in a surgical intensive care unit was associated with earlier enteral feeding.

摘要

目的

在外科重症监护病房接受术后治疗的患者常接受延迟肠内营养。我们假设，推行促进早期肠内营养的指南与更早开始肠内喂养有关。

方法

由重症监护医生、护士、营养师和外科医生组成的多学科团队达成共识，制定了肠内营养指南。通过反复的员工培训来实施这些指南。我们前瞻性地比较了一家三级医疗中心外科重症监护病房在指南实施前（干预前期，2008年1月27日至4月30日）和实施后（干预后期，2008年5月1日至8月15日）的营养支持数据。主要结局是开始肠内喂养的时间（口服或管饲）。

结果

干预前期评估了146例患者，干预后期评估了141例患者。两个时间段的患者在人口统计学和临床特征方面相似。没有患者营养缺失超过7天。干预后期开始口服或管饲营养的时间更早（中位数分别为1天和2天，p<0.001）。接受肠外营养的患者百分比没有差异（7.4%对10%，p=0.360）。干预后期误吸事件没有增加（8%对9.4%，p=0.606）。