Delaney Emer
Specialist Dietitian, Chelsea and Westminster Healthcare NHS Fdn Trust.
Br J Nurs. 2020 Oct 22;29(19):1096-1103. doi: 10.12968/bjon.2020.29.19.1096.
The following article was written after the initial wave of the COVID-19 pandemic in the UK. On reflection of clinical practice during this time, it was noted by the ICU team that the majority of ventilated patients appeared to have lost weight during their stay. Unfortunately, there was no ability to weigh patients during the pandemic, so this weight loss was a subjective observation. Regardless, this observation lead the ICU dietitian to retrospectively audit prescribed versus delivered feed. It was found that only 10% of admissions received the prescribed daily volume of feed within the first 7 days of admission. A further 6% of admissions were within 10% of achieving daily prescribed target volumes. The main reasons for this were proning patients, high gastric residual volumes and the overwhelming nature of the pandemic. Three areas of practice have been highlighted that will improve feed delivery should a second wave occur. 1. A nasojejunal team comprising 20 members of the ICU multidiciplinary team will be established to insert bedside nasojejunal tubes in all ICU patients on admission. 2. All proned patients will be enterally fed and practice adjusted as per British Dietetic Association recommendations. 3. The international enteral feeding guidelines regarding hypocaloric feeding for the first 7 days will not be followed due to minimal clinical evidence for the ICU COVID-19 demographic.
以下文章是在英国新冠疫情第一波高峰之后撰写的。重症监护病房（ICU）团队在反思这段时间的临床实践时注意到，大多数接受机械通气的患者在住院期间似乎体重减轻了。不幸的是，在疫情期间无法对患者进行称重，所以这种体重减轻是一种主观观察结果。尽管如此，这一观察结果促使ICU营养师对规定的喂食量与实际提供的喂食量进行回顾性审核。结果发现，只有10%的入院患者在入院后的前7天内接受了规定的每日喂食量。另有6%的入院患者达到了每日规定目标量的90%。造成这种情况的主要原因是患者俯卧位、胃残余量高以及疫情的严峻性。文中强调了三个实践领域，若第二波疫情来袭，这些领域将有助于改善喂食情况。1. 将成立一个由20名ICU多学科团队成员组成的鼻空肠管置入小组，在所有ICU患者入院时床边置入鼻空肠管。2. 所有俯卧位患者都将接受肠内营养，并根据英国饮食协会的建议调整实践操作。3. 由于针对ICU新冠患者群体的临床证据极少，因此将不遵循国际肠内营养指南中关于前7天低热量喂养的建议。
