Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoecho, Sakyo-ku, Kyoto-city, Japan.
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoecho, Sakyo-ku, Kyoto-city, Japan; Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan.
Resuscitation. 2019 Feb;135:191-196. doi: 10.1016/j.resuscitation.2019.01.007. Epub 2019 Jan 14.
Early enteral nutrition (EN) is recommended for critically ill patients; however, few reports have examined early EN for patients who received targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). We investigated the effectiveness and safety of early EN for patients who received TTM after OHCA.
We used a nationwide Japanese administrative database to identify OHCA patients who received TTM from April 2008 to March 2017. The primary outcome was 30-day mortality; secondary outcomes were incidences of all-cause infection, pneumonia, and intestinal ischemia.
Of the 1932 OHCA patients who received TTM, 1682 met the inclusion criteria. Of these, 294 received early EN within 2 days from the initiation of TTM and 266 propensity-score matched pairs were generated. Cox regression analyses revealed no significant difference in 30-day mortality between groups (hazard ratio (HR): 0.90; 95% confidence interval (95% CI): 0.65-1.25). There was no significant difference in the incidence of all-cause infection (odds ratio (OR): 0.98; 95% CI: 0.66-1.46) or pneumonia (OR: 1.02; 95% CI: 0.68-1.55). Subgroup analyses of patients with a low body mass index (BMI; kg/m2) (< 18.5) revealed a significant decrease of 30-day mortality in the early EN group (HR: 0.30; 95% CI: 0.092-0.97) but no significant difference among patients with a BMI ≥ 18.5 (HR: 1.01; 95% CI: 0.72-1.43).
Among patients who received TTM after OHCA, there was no significant association between early EN and 30-day mortality; however, early EN could be beneficial for patients with a low BMI.
推荐对危重症患者进行早期肠内营养（EN）；然而，很少有研究报道对接受院外心脏骤停（OHCA）后目标温度管理（TTM）的患者进行早期 EN。我们研究了对接受 OHCA 后 TTM 的患者进行早期 EN 的有效性和安全性。
我们使用一个全国性的日本行政数据库来确定 2008 年 4 月至 2017 年 3 月期间接受 TTM 的 OHCA 患者。主要结局是 30 天死亡率；次要结局是全因感染、肺炎和肠缺血的发生率。
在 1932 名接受 TTM 的 OHCA 患者中，有 1682 名符合纳入标准。其中，294 名患者在 TTM 开始后 2 天内接受了早期 EN，产生了 266 对倾向评分匹配的患者。Cox 回归分析显示两组 30 天死亡率无显著差异（风险比（HR）：0.90；95%置信区间（95%CI）：0.65-1.25）。全因感染发生率（优势比（OR）：0.98；95%CI：0.66-1.46）或肺炎（OR：1.02；95%CI：0.68-1.55）也无显著差异。低体重指数（BMI；kg/m2）（<18.5）患者的亚组分析显示，早期 EN 组 30 天死亡率显著降低（HR：0.30；95%CI：0.092-0.97），但 BMI≥18.5 患者之间无显著差异（HR：1.01；95%CI：0.72-1.43）。
在接受 OHCA 后接受 TTM 的患者中，早期 EN 与 30 天死亡率之间无显著关联；然而，早期 EN 可能对 BMI 较低的患者有益。
