Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia.
JPEN J Parenter Enteral Nutr. 2021 Aug;45(6):1327-1337. doi: 10.1002/jpen.2019. Epub 2020 Oct 1.
Enteral nutrition (EN) is an essential therapeutic intervention. Many studies internationally have reviewed feeding practices in intensive care units (ICUs) and recorded the incidence of underfeeding in these settings, yet none were performed in the Middle East, including Saudi Arabia. The purpose of the study is to assess the adequacy of EN delivery and investigate the enteral feeding practices in the ICU at a specialized tertiary care hospital in Saudi Arabia.
In this observational study, we prospectively monitored energy and protein delivery for 6 consecutive days in critically ill patients. Malnutrition was assessed by Nutrition Risk Screening (NRS-2002) scores. Underfeeding was identified by comparing the intake against the calculated requirements. Patients were categorized into early and late EN starters to investigate whether the time of EN initiation impacts the cumulative nutrition intake.
This study included 43 patients. About 44% (19 of 43) of the patients were malnourished on admission to ICU, and the prevalence of underfeeding was >90%. The median cumulative intake of energy and protein was 39% and 31% of the estimated requirements, respectively. Patients who started early EN had statistically higher cumulative energy and protein intake (P-value = .00). Patients treated with inotropes received less energy and protein compared with those who did not receive inotropes (P-value = .00). Higher NRS-2002 score was associated with fewer ventilation-free hours (r = -0.369, P-value = .045).
Protein underfeeding remains a significant problem in ICU settings. The time of EN initiation plays a major role in determining when the nutrition requirements will be met. Therefore, it is crucial to implement effective feeding protocols to ensure early initiation of EN when permissible.
肠内营养（EN）是一种重要的治疗干预手段。许多国际研究都对重症监护病房（ICU）的喂养实践进行了回顾，并记录了这些环境中的喂养不足发生率，但在中东地区，包括沙特阿拉伯，都没有进行过此类研究。本研究的目的是评估 EN 输送的充分性，并调查沙特一家专门的三级护理医院 ICU 的肠内喂养实践。
在这项观察性研究中，我们连续 6 天对危重患者的能量和蛋白质输送进行了前瞻性监测。通过营养风险筛查（NRS-2002）评分评估营养不良。通过将摄入量与计算的需求量进行比较来确定喂养不足。将患者分为早期和晚期肠内营养启动者，以调查肠内营养启动时间是否会影响累积营养摄入量。
本研究纳入了 43 名患者。大约 44%（43 名患者中的 19 名）在入 ICU 时就已经存在营养不良，喂养不足的患病率超过 90%。能量和蛋白质的累积摄入量中位数分别为估计需求量的 39%和 31%。早期开始肠内营养的患者的累积能量和蛋白质摄入量有统计学上的显著增加（P 值 =.00）。与未使用血管加压药的患者相比，使用血管加压药的患者接受的能量和蛋白质较少（P 值 =.00）。NRS-2002 评分越高，无通气时间越少（r = -0.369，P 值 =.045）。
蛋白质喂养不足仍然是 ICU 环境中的一个重大问题。肠内营养启动的时间在确定何时能满足营养需求方面起着重要作用。因此，实施有效的喂养方案以确保在允许的情况下尽早启动肠内营养至关重要。
