Department of Nutrition and Dietetics, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia; Centre of Clinical Research Excellence (CRE) in Translating Science to Good Health, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia; Discipline of Acute Care Medicine, The University of Adelaide, Frome Rd, Adelaide, 5000, Australia.
Department of Critical Care Services, Trauma Services, Royal Adelaide Hospital, Port Rd, Adelaide, 5000, Australia.
Aust Crit Care. 2019 May;32(3):237-242. doi: 10.1016/j.aucc.2018.04.004. Epub 2018 Jun 11.
Optimising nutrition support in critically ill patients with an open abdomen is challenging.
The aims of this study were to (i) quantify the amount and adequacy of nutrition support administered and (ii) determine any relationships that exist between mode of nutrition support delivery and clinical outcomes in critically ill patients with an open abdomen.
A retrospective review of critically ill patients mechanically ventilated for at least 48 h with an open abdomen in a mixed quaternary referral intensive care unit. Enteral and parenteral nutrition (ml) administered daily to patients was recorded for up to 21 days. Length of stay in the intensive care unit and hospital and duration of mechanical ventilation (days) were reported.
Thirty patients were studied [14 male, 68 y (15-90 y), body mass index 25 kg/m (11-51 kg/m), Acute Physiology and Chronic Health Evaluation II score 20 (7-41), energy goal 1860 kcal/d (1250-2712 kcal/d)]. Patients received 55% (0-117%) of energy goal and 56% (0-105%) protein goal from either enteral or parenteral nutrition. When enteral nutrition was delivered alone or in combination with parenteral nutrition, patients received 48% (0-146%) of their energy and 59% (19-105%) of their protein goal. Patients fed parenteral nutrition, either alone or as supplementary to enteral nutrition (n = 18), received more energy when compared with those who only received enteral nutrition (n = 9) [65 (27-117) vs 49 (15-89) % energy goal, P = 0.025]. Parenteral nutrition was associated with an increased length of stay in hospital [63 (45-156) vs 45 (17-93) d, P = 0.037].
Patients with an open abdomen receive about half of their nutrition requirements when fed exclusively via the enteral route. Providing combination enteral and parenteral nutrition to reach nutritional goals may not result in better clinical outcomes for patients with an open abdomen.
为并发开放性腹部的危重症患者提供最佳的营养支持颇具挑战。
本研究旨在：(i) 量化给予患者的营养支持的量和充分性；以及 (ii) 确定在并发开放性腹部的危重症患者中，营养支持输送模式与临床结局之间存在的任何关联。
对在混合四级转诊重症监护病房中接受机械通气至少 48 小时且并发开放性腹部的危重症患者进行回顾性分析。记录患者每天接受的肠内和肠外营养（ml），最长可达 21 天。报告患者在重症监护病房和医院中的住院时间以及机械通气时间（天）。
共纳入 30 例患者[14 例男性，68 岁（15-90 岁），体重指数 25kg/m（11-51kg/m），急性生理学与慢性健康状况评分系统 II 评分 20 分（7-41 分），能量目标 1860kcal/d（1250-2712kcal/d）]。患者接受的能量目标为 55%（0-117%），蛋白质目标为 56%（0-105%），分别来自肠内或肠外营养。当仅给予肠内营养或联合肠外营养时，患者接受的能量分别为 48%（0-146%）和蛋白质分别为 59%（19-105%）。与仅接受肠内营养的患者相比，接受肠外营养（单独或作为肠内营养的补充）的患者接受的能量更多[65（27-117）% vs 49（15-89）%能量目标，P=0.025]。肠外营养与住院时间延长相关[63（45-156）vs 45（17-93）d，P=0.037]。
当仅通过肠内途径给予营养时，并发开放性腹部的患者接受的营养需求约为其一半。为达到营养目标而给予肠内和肠外联合营养可能不会使并发开放性腹部的患者获得更好的临床结局。
