Houston Methodist Hospital, Houston, Texas, USA.
JPEN J Parenter Enteral Nutr. 2020 Aug;44(6):1038-1046. doi: 10.1002/jpen.1727. Epub 2019 Oct 21.
The importance of enteral nutrition (EN) in critically ill patients is well documented. However, actual administration of EN frequently does not amount to prescribed nutrition goals. Persistent underfeeding may lead to impaired immune response, increased mortality, and higher costs. Traditionally, EN uses a rate-based approach, utilizing slow titration to goal and a final fixed hourly rate, regardless of interruptions in feeding. Volume-based feeding (VBF) establishes a 24-hour EN goal volume, and the rate varies to achieve this daily goal when interruptions occur.
This was a retrospective, single-center, quasi-experimental study comparing traditional rate-based feeding (RBF) to VBF in adult patients admitted to the medical and neurosurgical intensive care units (ICUs). The primary outcome was mean percentage of total goal energy received after EN initiation until 7 days, transfer from ICU, removal of feeding tube, or oral diet order placed. Secondary outcomes included mean percentage of total goal protein received, percentage of patients meeting 80% of nutrition goals, incidence of gastric residual volumes >400 mL, and incidence of moderate hyperglycemia (>250 mg/dL).
The study enrolled 189 patients. Mean percentage of goal energy delivered (75% RBF, 102% VBF; P < .001) and goal protein delivered (68% RBF, 87% VBF; P < .001) was significantly higher with VBF compared with RBF.
VBF demonstrated a significant increase in energy and protein delivery with no major safety or tolerability issues. VBF should be considered for use in ICU patients to optimize nutrition delivery.
肠内营养（EN）在危重症患者中的重要性已有充分的文献记载。然而，实际给予的 EN 常常达不到规定的营养目标。持续的喂养不足可能导致免疫反应受损、死亡率增加和成本增加。传统上，EN 采用基于速率的方法，通过缓慢滴定至目标和最终固定的每小时速率，而不管喂养中断与否。基于容量的喂养（VBF）设定 24 小时 EN 目标容量，当发生中断时，该速率会变化以实现每日目标。
这是一项回顾性、单中心、准实验研究，比较了传统的基于速率的喂养（RBF）与 VBF 在入住内科和神经外科重症监护病房（ICU）的成年患者中的应用。主要结局是从 EN 开始到 7 天、从 ICU 转出、拔管或开始口服饮食时，总目标能量的实际接受百分比。次要结局包括总目标蛋白的实际接受百分比、达到 80%营养目标的患者百分比、胃残留量>400 mL 的发生率以及中度高血糖（>250 mg/dL）的发生率。
该研究纳入了 189 名患者。与 RBF 相比，VBF 输送的目标能量百分比（75% RBF，102% VBF；P <.001）和目标蛋白百分比（68% RBF，87% VBF；P <.001）显著更高。
与 RBF 相比，VBF 显著提高了能量和蛋白质的输送，且没有出现重大的安全性或耐受性问题。VBF 应考虑用于 ICU 患者，以优化营养输送。
