Department of General Intensive Care, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Division of Clinical Nutrition, Department of Medicine, Thailand, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Nutrition. 2021 Apr;84:111117. doi: 10.1016/j.nut.2020.111117. Epub 2020 Dec 14.
High-flow nasal-cannula (HFNC) oxygen therapy is increasingly used in the management of respiratory distress. Since this treatment may be required for many days and may impair nutritional intake, this study planned to observe the energy and protein intake of individuals receiving this therapy.
Forty consecutive patients requiring HFNC oxygenation after extubation or to prevent intubation from November 2017 to June 2018 were included in the study. Demographics, route of nutrition (oral, enteral, or parenteral), calories and protein prescribed and administered, and complications were noted until discharge. Statistical analysis used χ or Kruskal-Wallis H test.
HFNC oxygen therapy was applied for 42 d in the 40 participants. Overall, individuals with HFNC oxygenation therapy received 449.5 (interquartile range [IQR], 312-850) kcal/d and 19.25 (IQR, 13.9-33.3) g/d protein. Twenty-one participants treated with enteral nutrition received 387 (IQR, 273-931) kcal/d and 18.5 (IQR, 13.9-33.3) g/d protein, whereas those with oral feeding (n = 13) received higher totals of calories, 600 (IQR, 459-850) kcal/d (P = 0.056), and protein, 22 (IQR, 20-45) g/d (P = 0.005). Four participants received parenteral nutrition alone, providing 543 (IQR, 375-886.5) kcal/d and 8.7 (IQR, 0-20) g/d protein. When parenteral nutrition was administered with enteral nutrition, it provided only 324 (IQR, 290-358) kcal/d. Two participants did not receive any nutritional support. The overall length of stay in the intensive care unit was 8 (IQR, 5-17.5) d. Participants receiving enteral nutrition had a longer stay (14 d; IQR, 8-20) than the oral-diet group (4 d; IQR, 2-10; P < 0.03). The rate of intubation after HFNC therapy was not significantly different between the groups (P = 0.586).
Administration of HFNC oxygen therapy was associated with significant underfeeding. In order to reach optimal caloric and protein intake, parenteral nutrition may be considered.
高流量鼻导管（HFNC）氧疗在呼吸窘迫的治疗中应用越来越广泛。由于这种治疗可能需要持续多天，并且可能会影响营养摄入，因此本研究计划观察接受这种治疗的个体的能量和蛋白质摄入情况。
2017 年 11 月至 2018 年 6 月期间，连续纳入 40 例因拔管或预防插管而需要 HFNC 氧疗的患者。记录患者的人口统计学数据、营养途径（口服、肠内或肠外）、规定和给予的热量和蛋白质以及并发症，直至出院。统计分析采用 χ 或 Kruskal-Wallis H 检验。
40 名患者中有 4 名接受 HFNC 氧疗 42 天。总体而言，HFNC 氧疗患者接受的热量为 449.5（四分位距[IQR]，312-850）kcal/d，蛋白质为 19.25（IQR，13.9-33.3）g/d。21 名接受肠内营养治疗的患者接受的热量为 387（IQR，273-931）kcal/d，蛋白质为 18.5（IQR，13.9-33.3）g/d，而接受口服喂养（n=13）的患者接受的热量更高，为 600（IQR，459-850）kcal/d（P=0.056），蛋白质为 22（IQR，20-45）g/d（P=0.005）。4 名患者单独接受肠外营养，提供 543（IQR，375-886.5）kcal/d 和 8.7（IQR，0-20）g/d 蛋白质。当肠外营养与肠内营养联合应用时，仅提供 324（IQR，290-358）kcal/d。有 2 名患者未接受任何营养支持。患者在重症监护病房的总住院时间为 8（IQR，5-17.5）d。接受肠内营养的患者的住院时间（14 d；IQR，8-20）长于口服饮食组（4 d；IQR，2-10；P < 0.03）。HFNC 治疗后插管率在各组之间无显著差异（P=0.586）。
HFNC 氧疗的应用与明显的喂养不足有关。为了达到最佳的热量和蛋白质摄入，可能需要考虑肠外营养。
