Department of Nursing, School of Clinical Sciences, Auckland University of Technology (AUT), Auckland, New Zealand.
Intensive Care Unit, Intensive Care Services, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand.
Nurs Crit Care. 2018 Jul;23(4):179-185. doi: 10.1111/nicc.12343. Epub 2018 Apr 16.
Timely and adequate nutrition improves health outcomes for the critically ill patient. Despite clinical guidelines recommending early oral nutrition, survivors of critical illness experience significant nutritional deficits. This cohort study evaluates the oral nutrition intake in intensive care unit (ICU) patients who have experienced recent critical illness. The oral nutrition intake of a convenience sample of ICU patients post-critical illness was observed during a 1-month period. Data pertaining to both the amount of oral nutrition intake and factors impacting optimal oral nutrition intake were collected and analysed. Inadequate oral intake was identified in 62% of the 79 patients assessed (n = 49). This was noted early in the ICU stay, around day 1-2, for most of the patients. A significant proportion (25%) of patients remained in the hospital with poor oral intake that persisted beyond ICU day 5. Unsurprisingly, these were the patients who had longer ICU stays. Critical illness weakness was a factor in the assessment of poor oral intake. To conclude, patients who have experienced critical illness also experience suboptimal oral nutrition. The three key factors that were identified as impacting optimal oral nutrition were early removal of nasogastric tubes, critical illness weakness and poor appetite post-critical illness. Seven key recommendations are made based on this cohort study. These recommendations are related to patient assessment, monitoring, documentation and future guidelines. Future research opportunities are highlighted, including the investigation of strategies to improve the transition of patients' post-critical illness to oral nutrition.
及时和充足的营养可改善重症患者的健康状况。尽管临床指南建议早期进行口服营养，但危重病幸存者仍会经历严重的营养不足。这项队列研究评估了最近经历过危重病的重症监护病房（ICU）患者的口服营养摄入量。在一个月的时间内，观察了 ICU 患者在经历危重病后的口服营养摄入量。收集并分析了与口服营养摄入量和影响最佳口服营养摄入量的因素有关的数据。在评估的 79 名患者中（n=49），有 62%的患者存在口服摄入不足。这在大多数患者的 ICU 入住早期（第 1-2 天）就已经出现。相当一部分（25%）的患者在医院仍存在不良的口服摄入，这种情况持续到 ICU 入住第 5 天以后。不出所料，这些患者的 ICU 入住时间更长。危重病导致的虚弱是评估不良口服摄入的一个因素。总之，经历过危重病的患者也会经历不理想的口服营养。被确定为影响最佳口服营养的三个关键因素是尽早移除鼻胃管、危重病导致的虚弱和危重病后缺乏食欲。根据这项队列研究提出了 7 条关键建议。这些建议与患者评估、监测、记录和未来指南有关。还强调了未来的研究机会，包括研究改善患者从危重病后过渡到口服营养的策略。
