Bendavid Itai, Singer Pierre, Theilla Miriam, Themessl-Huber Michael, Sulz Isabella, Mouhieddine Mohamed, Schuh Christian, Mora Bruno, Hiesmayr Michael
Department of Critical Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital and Sackler School of Medicine, Tel Aviv University, 49100, Israel.
Department of Critical Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital and Sackler School of Medicine, Tel Aviv University, 49100, Israel.
Clin Nutr. 2017 Aug;36(4):1122-1129. doi: 10.1016/j.clnu.2016.07.012. Epub 2016 Aug 9.
To determine the nutrition practice in intensive care units and the associated outcome across the world, a yearly 1 day cross sectional audit was performed from 2007 to 2013. The data of this initiative called "nutritionDay ICU" were analyzed.
A questionnaire translated in 17 languages was used to determine the unit's characteristics, patient's condition, nutrition condition and therapy as well as outcome. All the patients present in the morning of the 1 day prevalence study were included from 2007 to 2013.
9777 patients from 46 countries and 880 units were included. Their SAPS 2 was median 38 (IQR 27-51), predicted mortality was 30.7% ± 26.9, and their SOFA score 4.5 ± 3.4 with median 4 (IQR 2-7). Administration of calories did not appear to be related to actual or ideal body weight within all BMI groups. Patients with a BMI <18.5 or >40 received slightly less calories than all other BMI groups. Two third of the patients were either ventilated or were in the ICU for longer than 24 h at nutritionDay. Routes of feeding used were the oral, enteral and parenteral routes. More than 40% of the patients were not fed during the first day. The mean energy administered using enteral route was 1286 ± 663 kcal/day and using parenteral nutrition 1440 ± 652 kcal/day. 60 days mortality was 26.0%.
This very large collaborative cohort study shows that most of the patients are underfed during according to actual recommendations their ICU stay. Prescribed calories appear to be ordered regardless to the ideal weight of the patient. Nutritional support is slow to start and never reaches the recommended targets. Parenteral nutrition prescription is increasing during the ICU stay but reaching only 20% of the population studied if ICU stay is one week or longer. The nutritional support worldwide does not seem to be guided by weight or disease but more to be standardized and limited to a certain level of calories. These observations are showing the poor observance to guidelines.
为了确定全球重症监护病房的营养实践及相关结果，于2007年至2013年开展了一项为期一年的单日横断面审计。对这项名为“重症监护病房营养日”倡议的数据进行了分析。
使用一份翻译成17种语言的问卷来确定病房特征、患者状况、营养状况和治疗以及结果。纳入了2007年至2013年患病率研究当日上午所有在场的患者。
纳入了来自46个国家880个病房的9777名患者。他们的简化急性生理学评分系统（SAPS）2中位数为38（四分位间距27 - 51），预测死亡率为30.7%±26.9，序贯器官衰竭评估（SOFA）评分4.5±3.4，中位数为4（四分位间距2 - 7）。在所有体重指数（BMI）组中，热量供应似乎与实际体重或理想体重无关。BMI<18.5或>40的患者比所有其他BMI组接受的热量略少。三分之二的患者在营养日时要么接受机械通气，要么在重症监护病房停留超过24小时。采用的喂养途径包括口服、肠内和肠外途径。超过40%的患者在第一天未接受喂养。肠内途径的平均能量供应为1286±
