Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA.
Clinical Nutrition, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA.
JPEN J Parenter Enteral Nutr. 2020 Jul;44(5):874-879. doi: 10.1002/jpen.1711. Epub 2019 Sep 18.
Critically ill patients on enteral nutrition (EN) often do not receive goal nutrition support. Factors impeding delivery of EN include interruption for procedures, tube dislodgement, and high gastric residuals. A volume-based feeding protocol (VP) is designed to adjust the infusion rate to compensate for interruptions. We hypothesize that implementation of a VP would increase delivery of EN over the conventional hourly rate method (CM).
This study compared patients on CM to those on VP. The primary outcome measured was percentage of goal EN delivered during the entire intensive care unit (ICU) stay. Inclusion criteria for the study consisted of patients aged >18 years, traumatic mechanism of injury and admission to the ICU >72 hours, hemodynamic stability to receive EN per the trauma ICU standard of practice, and EN via nasogastric or post-pyloric feeding tube.
We evaluated 227 patients over a 20-month period. Seventy-nine patients in the VP group were compared with the control group of 148 patients. Patients on VP received a significantly higher percentage of goal EN than those on CM (73.3% vs 65%, P = .0002). There was no difference in the incidence of diarrhea (CM 4.16% vs VP 5.19%; P = .29) or tube dislodgment (CM 2.04% vs VP 1.61%; P = .51).
Implementation of a VP significantly increased delivery of EN by 8.3% over that given by the CM in critically ill trauma patients with no difference in feeding-related complications.
接受肠内营养（EN）的危重症患者通常无法获得目标营养支持。妨碍 EN 输送的因素包括程序中断、管脱落和胃残留量高。基于容量的喂养方案（VP）旨在调整输注速度以补偿中断。我们假设实施 VP 将增加 EN 的输送量，超过传统的每小时速率方法（CM）。
本研究将接受 CM 的患者与接受 VP 的患者进行比较。主要观察指标是整个重症监护病房（ICU）入住期间目标 EN 输送的百分比。研究纳入标准包括年龄>18 岁、创伤性损伤机制和 ICU 入住>72 小时、血流动力学稳定以根据创伤 ICU 标准接受 EN，以及通过鼻胃管或幽门后喂养管进行 EN。
我们在 20 个月的时间内评估了 227 名患者。将 79 名 VP 组患者与对照组的 148 名患者进行比较。VP 组患者接受的目标 EN 百分比明显高于 CM 组（73.3%比 65%，P=0.0002）。腹泻发生率（CM 为 4.16%，VP 为 5.19%；P=0.29）或管脱落发生率（CM 为 2.04%，VP 为 1.61%；P=0.51）无差异。
在没有与喂养相关的并发症差异的情况下，在接受危重症创伤患者中，与 CM 相比，VP 可显著增加 8.3%的 EN 输送量。
