Brown Ann-Marie, Madsen Erik C, Leonard Charlene P, Leslie Sharon L, Allen Christine, Srinivasan Vijay, Irving Sharon Y
Ann-Marie Brown is an assistant clinical professor at Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, and a nurse practitioner in pediatric intensive care at Akron Children's Hospital, Akron, Ohio.
Erik C. Madsen is an assistant professor of pediatrics at Saint Louis University and a pediatric intensivist at Cardinal Glennon Children's Hospital, St Louis, Missouri.
Am J Crit Care. 2020 Jan 1;29(1):33-45. doi: 10.4037/ajcc2020850.
Nutrition guidelines recommend enteral nutrition in the form of gastric feedings for critically ill children and acknowledge a lack of evidence describing an optimal method for providing these feedings.
To determine the state of the science regarding the efficacy of bolus (intermittent) or continuous gastric feedings to improve nutrition delivery in critically ill children receiving mechanical ventilation.
Five hundred seventy-nine abstracts met the inclusion criteria and were screened by 2 reviewers according to prespecified criteria. Full-text reviews were performed on 28 articles; 11 studies were selected for detailed analysis. Because of the small number of eligible studies, broader searches were conducted.
Only 5 studies with a collective enrollment of fewer than 200 children closely addressed the specific research question. These 5 studies did not report any similarity in feeding regimens, nor did they report nutritional outcomes. Two of the articles described findings from the same study population. Although 4 of the 5 studies randomized children to bolus versus continuous feedings, only 3 studies described attainment of nutrient delivery goals in both the intervention and the control groups; the remaining study did not report this outcome. The heterogeneity in methodology and outcomes among the 5 studies did not allow for a meta-analysis.
The dearth of evidence regarding best practices and outcomes related to bolus versus continuous gastric feedings in critically ill children receiving mechanical ventilation requires additional rigorous investigation.
营养指南推荐对危重症儿童采用胃内喂养的肠内营养方式，并承认缺乏描述提供这些喂养的最佳方法的证据。
确定关于推注（间歇性）或持续胃内喂养对接受机械通气的危重症儿童改善营养输送效果的科学现状。
579篇摘要符合纳入标准，并由2名评审员根据预先设定的标准进行筛选。对28篇文章进行了全文评审；选择了11项研究进行详细分析。由于符合条件的研究数量较少，进行了更广泛的检索。
仅有5项研究共纳入不到200名儿童，密切关注了具体研究问题。这5项研究未报告喂养方案有任何相似之处，也未报告营养结果。其中2篇文章描述了同一研究人群的研究结果。虽然5项研究中有4项将儿童随机分为推注喂养组和持续喂养组，但只有3项研究描述了干预组和对照组实现营养输送目标的情况；其余1项研究未报告此结果。这5项研究在方法和结果上的异质性不允许进行荟萃分析。
对于接受机械通气的危重症儿童，关于推注喂养与持续胃内喂养的最佳实践和结果缺乏证据，需要进行更多严格的研究。
