普通重症监护病房中肠内营养处方与实施差异的相关因素。
Factors associated with discrepancy between prescribed and administered enteral nutrition in general ICU.
机构信息
University of Oulu, Medical Research Center, Research Group of Surgery, Anaesthesia and Intensive Care and Department of Anaesthesiology, Oulu University Hospital, Oulu, Finland.
出版信息
Eur J Clin Nutr. 2020 Feb;74(2):248-254. doi: 10.1038/s41430-019-0451-8. Epub 2019 Jun 13.
BACKGROUND
Discrepancy between prescribed and administered enteral nutrition (EN) is a common problem during intensive care. The aim of this study was to find out the success rate and factors associated with inadequacy of enteral nutrition in a mixed general intensive care unit (ICU).
METHODS
This was a retrospective single-center study of 892 patients with ICU length of stay (LOS) ≥4 days. The factors associated with adequacy of enteral nutrition on day 4 were analyzed. These included disease-specific factors, patient-related factors, severity of illness, and procedural factors.
RESULTS
Of the 892 patients, 349 (39.1%) had an EN success rate of ≥70%, which was associated with a lower amount of prescribed enteral energy (500 kcal [500-800] vs. 800 kcal [500-1200], p < 0.001) and bolus administration of enteral nutrition (41 of 349 vs. 27 of 543, p < 0.001). Other factors impairing successful EN were severe inflammation, surgery, and GI-related admission diagnosis.
CONCLUSIONS
On the fourth day during ICU stay discrepancy between prescribed and administered enteral nutrition was associated to severe inflammation, GI-related diagnosis, and prescribing policy.
背景
在重症监护期间，规定的肠内营养（EN）与实际给予的肠内营养之间存在差异是一个常见问题。本研究的目的是了解混合普通重症监护病房（ICU）中肠内营养不足的成功率和相关因素。
方法
这是一项回顾性单中心研究，共纳入 892 名 ICU 住院时间（LOS）≥4 天的患者。分析了与第 4 天肠内营养充足相关的因素。这些因素包括疾病特异性因素、患者相关因素、疾病严重程度和程序因素。
结果
在 892 名患者中，349 名（39.1%）的肠内营养成功率≥70%，这与规定的肠内能量摄入较低（500 千卡[500-800] vs. 800 千卡[500-1200]，p<0.001）和肠内营养推注给药有关（349 名中有 41 名 vs. 543 名中有 27 名，p<0.001）。其他影响成功肠内营养的因素包括严重炎症、手术和与胃肠道相关的入院诊断。
结论
在 ICU 住院的第四天，规定的和实际给予的肠内营养之间的差异与严重炎症、胃肠道相关诊断和处方政策有关。
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