Shah Sunish, Hollands James M, Pontiggia Laura, Bingham Angela L
Department of Pharmacy Practice and Pharmacy Administration, University of the Sciences, Philadelphia, PA, USA.
Department of Mathematics, Physics, and Statistics, University of the Sciences, Philadelphia, PA, USA.
Nutr Metab Insights. 2019 Jul 3;12:1178638819859315. doi: 10.1177/1178638819859315. eCollection 2019.
The optimal time to initiate parenteral nutrition (PN) in critically ill adults in whom enteral nutrition is not feasible is controversial.
The objectives were to compare in-hospital mortality and hospital length of stay in patients initiated on PN within 7 days or after 7 days of poor nutrient intake.
This single-center, retrospective study included critically ill adult patients who received at least 2 consecutive days of PN during hospitalization from May 2014 to July 2016.
The median duration of PN (interquartile range) was 8 (5-13) days. In total, 110 patients received PN within 7 days of poor nutrient intake while 49 patients received PN after 7 days of poor nutrient intake. There was no statistically significant difference in in-hospital mortality between groups (29.09% vs 18.37%, = .1535). Patients initiated within 7 days had a significantly shorter median hospital length of stay than patients initiated after 7 days (20 days vs 27 days, = .0013). There were 69 patients who were classified as obese. Obese patients initiated within 7 days had a significantly shorter median hospital length of stay than obese patients initiated after 7 days (17 days vs 33 days, = .0007).
Time to initiation of PN did not impact in-hospital mortality. However, there was an association between early initiation of PN and a shorter hospital length of stay that was most pronounced among obese patients.
对于无法进行肠内营养的危重症成年患者，开始肠外营养（PN）的最佳时机存在争议。
比较营养摄入不足7天内或7天后开始接受PN治疗的患者的院内死亡率和住院时间。
这项单中心回顾性研究纳入了2014年5月至2016年7月住院期间接受至少连续2天PN治疗的危重症成年患者。
PN的中位持续时间（四分位间距）为8（5-13）天。共有110例患者在营养摄入不足7天内接受PN治疗，49例患者在营养摄入不足7天后接受PN治疗。两组间院内死亡率无统计学显著差异（29.09%对18.37%，P = 0.1535）。7天内开始治疗的患者的中位住院时间明显短于7天后开始治疗的患者（20天对27天，P = 0.0013）。有69例患者被归类为肥胖。7天内开始治疗的肥胖患者的中位住院时间明显短于7天后开始治疗的肥胖患者（17天对33天，P = 0.0007）。
开始PN的时间不影响院内死亡率。然而，早期开始PN与较短的住院时间之间存在关联，这在肥胖患者中最为明显。
