Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Clin Nutr. 2021 Mar;40(3):1310-1317. doi: 10.1016/j.clnu.2020.08.014. Epub 2020 Aug 27.
BACKGROUND & AIMS: Malnutrition leads to poor outcomes for critically ill patients; however, underfeeding remains a prevalent issue in the intensive care unit (ICU). One of the reasons for underfeeding is enteral nutrition interruption (ENI). Our aim was to investigate the causes, frequency, and duration of ENIs and their association with underfeeding in critical care.
This was a prospective observational study conducted at the Vilnius University Hospital Santaros Clinics, Lithuania, between December 2017 and February 2018. It included adult medical and surgical ICU patients who received enteral nutrition (EN). Data on ENIs and caloric, as well as protein intake were collected during the entire ICU stay. Nutritional goals were assessed using indirect calorimetry, where available.
In total 73 patients were enrolled in the study. Data from 1023 trial days and 131 ENI episodes were collected; 68% of the patients experienced ENI during the ICU stay, and EN was interrupted during 35% of the trial days. The main reasons for ENIs were haemodynamic instability (20%), high gastric residual volume (GRV) (17%), tracheostomy (16%), or other surgical interventions (16%). The median duration of ENI was 12 [6-24] h, and the longest ENIs were due to patient-related factors (22 [12-42] h). The rate of underfeeding was 54% vs. 15% in the trial days with and without ENI (p < 0.001), respectively. Feeding goal was achieved in 26% of the days with ENI vs. 45% of days without ENI (p < 0.001). The daily average caloric provision was 77 ± 36% vs. 106 ± 29% in the trial days with and without ENI (p < 0.001) and protein provision was 0.96 ± 0.5 vs. 1.3 ± 0.5 g/kg, respectively (p < 0.001).
The episodes of ENI in critically ill patients are frequent and prolonged, often leading to underfeeding. Similar observations have been reported by other studies; however, the causes and duration of ENI vary, mainly because of different practices worldwide. Hence, safe and internationally recognised reduced-fasting guidelines and protocols for critically ill patients are needed in order to minimise ENI-related underfeeding and malnutrition.
营养不良会导致危重症患者预后不良；然而，在重症监护病房（ICU）中，喂养不足仍然是一个普遍存在的问题。喂养不足的原因之一是肠内营养中断（ENI）。我们的目的是调查 ICU 中 ENI 的原因、频率和持续时间及其与喂养不足的关系。
这是一项在立陶宛维尔纽斯大学Santaros 诊所进行的前瞻性观察研究，于 2017 年 12 月至 2018 年 2 月期间进行。纳入了接受肠内营养（EN）的成年内科和外科 ICU 患者。在整个 ICU 住院期间收集了关于 ENI 和热量以及蛋白质摄入的数据。在可行的情况下，使用间接热量测定法评估营养目标。
共有 73 名患者入组研究。共收集了 1023 个试验日和 131 次 ENI 发作的数据；68%的患者在 ICU 期间经历了 ENI，35%的试验日中断了 EN。ENI 的主要原因是血流动力学不稳定（20%）、胃残留量高（GRV）（17%）、气管造口术（16%）或其他外科干预（16%）。ENI 的中位持续时间为 12 [6-24] 小时，最长的 ENI 是由于患者相关因素（22 [12-42] 小时）。ENI 试验日的喂养不足率为 54%，无 ENI 试验日的喂养不足率为 15%（p<0.001）。ENI 试验日的喂养目标达成率为 26%，无 ENI 试验日的喂养目标达成率为 45%（p<0.001）。ENI 试验日的每日平均热量供给为 77±36%，无 ENI 试验日的每日平均热量供给为 106±29%（p<0.001），蛋白质供给分别为 0.96±0.5 和 1.3±0.5 g/kg（p<0.001）。
危重症患者的 ENI 发作频繁且持续时间长，往往导致喂养不足。其他研究也有类似的观察结果；然而，ENI 的原因和持续时间有所不同，主要是因为全球实践不同。因此，需要为危重症患者制定安全且国际认可的减少禁食指南和方案，以尽量减少与 ENI 相关的喂养不足和营养不良。
