Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO.
Department of Pediatrics, Section of General Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO.
Pediatr Crit Care Med. 2017 Dec;18(12):1093-1098. doi: 10.1097/PCC.0000000000001302.
Evaluate the practice of providing enteral nutrition in critically ill children requiring noninvasive positive pressure ventilation.
Retrospective cohort study.
PICU within a quaternary care children's hospital.
PICU patients older than 30 days requiring noninvasive positive pressure ventilation for greater than or equal to 24 hours from August 2014 to June 2015. Invasive mechanical ventilation prior to noninvasive positive pressure ventilation and inability to receive enteral nutrition at baseline were additional exclusionary criteria.
None.
The primary outcome was enteral nutrition initiation within 24 hours of admission. Secondary outcomes included time to goal enteral nutrition rate, adequacy of nutrition, adverse events (pneumonia not present at admission, intubation after enteral nutrition initiation, feeding tube misplacement), and lengths of noninvasive positive pressure ventilation and PICU stay. Among those included (n = 562), the median age was 2 years (interquartile range, 39 d to 6.8 yr), 54% had at least one chronic condition, and 43% had malnutrition at baseline. The most common primary diagnosis was bronchiolitis/viral pneumonia. The median length of time on noninvasive positive pressure ventilation was 2 days (interquartile range, 2.0-4.0). Most (83%) required continuous positive airway pressure or bi-level support during their PICU course. Sixty-four percent started enteral nutrition within 24 hours, with 72% achieving goal enteral nutrition rate within 72 hours. Forty-nine percent and 44% received an adequate cumulative calorie and protein intake, respectively, during their PICU admission. Oral feeding was the most common delivery method. On multivariable analysis, use of bi-level noninvasive positive pressure ventilation (odds ratio, 0.40; 95% CI, 0.25-0.63) and continuous dexmedetomidine (odds ratio, 0.59; 95% CI, 0.35-0.97) were independently associated with decreased likelihood of early enteral nutrition. Twelve percent of patients had at least one adverse event.
A majority of patients requiring noninvasive positive pressure ventilation received enteral nutrition within 24 hours. However, less than half achieved caloric and protein goals during their PICU admission. Further investigation is warranted to determine the safety and effectiveness of early enteral nutrition in this population.
评估需要无创正压通气的危重症儿童提供肠内营养的实践。
回顾性队列研究。
一家四级儿童医院的 PICU。
2014 年 8 月至 2015 年 6 月期间，大于 30 天且需要无创正压通气大于等于 24 小时的 PICU 患者。在开始无创正压通气之前进行有创机械通气和基线时无法接受肠内营养是另外的排除标准。
无。
主要结果是入院后 24 小时内开始肠内营养。次要结果包括达到目标肠内营养率的时间、营养充足程度、不良事件（入院时无肺炎、肠内营养开始后插管、喂养管位置不当）以及无创正压通气和 PICU 住院时间。在纳入的患者中（n=562），中位年龄为 2 岁（四分位距，39 天至 6.8 岁），54%有至少一种慢性疾病，43%基线时存在营养不良。最常见的主要诊断是细支气管炎/病毒性肺炎。无创正压通气的中位时间为 2 天（四分位距，2.0-4.0）。大多数（83%）在 PICU 期间需要持续气道正压通气或双水平支持。64%的患者在 24 小时内开始肠内营养，72%的患者在 72 小时内达到目标肠内营养率。49%和 44%分别在 PICU 住院期间获得足够的累计热量和蛋白质摄入。口服喂养是最常见的输送方法。多变量分析显示，使用双水平无创正压通气（比值比，0.40；95%置信区间，0.25-0.63）和持续使用右美托咪定（比值比，0.59；95%置信区间，0.35-0.97）与早期肠内营养的可能性降低相关。12%的患者至少有一个不良事件。
需要无创正压通气的大多数患者在 24 小时内接受了肠内营养。然而，在 PICU 住院期间，不到一半的患者达到了热量和蛋白质目标。需要进一步研究以确定在该人群中早期肠内营养的安全性和有效性。
