Savio Raymond Dominic, Parasuraman Rajalakshmi, Lovesly Daphnee, Shankar Bhuvaneshwari, Ranganathan Lakshmi, Ramakrishnan Nagarajan, Venkataraman Ramesh
Department of Critical Care Medicine, Apollo Hospitals, Chennai, India.
Department of Dietetics, Apollo Hospitals, Chennai, India.
J Intensive Care Soc. 2021 Feb;22(1):41-46. doi: 10.1177/1751143719900100. Epub 2020 Jan 14.
To assess the feasibility, tolerance and effectiveness of enteral nutrition in critically ill patients receiving invasive mechanical ventilation in the prone position for severe Acute Respiratory Distress Syndrome (ARDS).
Prospective observational study conducted in a multidisciplinary critical care unit of a tertiary care hospital from January 2013 until July 2015. All patients with ARDS who received invasive mechanical ventilation in prone position during the study period were included. Patients' demographics, severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE II) score), baseline markers of nutritional status (subjective global assessment (SGA) and body mass index), details of nutrition delivery during prone and supine hours and outcomes (Length of stay and discharge status) were recorded.
Fifty-one patients met inclusion criteria out of whom four patients were excluded from analysis since they did not receive any enteral nutrition due to severe hemodynamic instability. The mean age of patients was 46.4 ± 12.9 years, with male:female ratio of 7:3. On admission, SGA revealed moderate malnutrition in 51% of patients and the mean APACHE II score was 26.8 ± 9.2. The average duration of prone ventilation per patient was 60.2 ± 30.7 h. All patients received continuous nasogastric/orogastric feeds. The mean calories (kcal/kg/day) and protein (g/kg/day) prescribed in the supine position were 24.5 ± 3.8 and 1.1 ± 0.2 while the mean calories and protein prescribed in prone position were 23.5 ± 3.6 and 1.1 ± 0.2, respectively. Percentage of prescribed calories received by patients in supine position was similar to that in prone position (83.2% vs. 79.6%; = 0.12). Patients received a higher percentage of prescribed protein in supine compared to prone position (80.8% vs. 75%, = 0.02). The proportion of patients who received at least 75% of the caloric and protein goals was 37 (78.7%) and 37 (78.7%) in supine and 32 (68.1%) and 21 (44.6%) in prone position.
In critically ill patients receiving invasive mechanical ventilation in the prone position, enteral nutrition with nasogastric/orogastric feeding is feasible and well tolerated. Nutritional delivery of calories and proteins in prone position is comparable to that in supine position.
评估在接受有创机械通气的重度急性呼吸窘迫综合征（ARDS）危重症患者中，俯卧位肠内营养的可行性、耐受性及有效性。
2013年1月至2015年7月在一家三级医院的多学科重症监护病房进行前瞻性观察研究。纳入研究期间所有接受俯卧位有创机械通气的ARDS患者。记录患者的人口统计学资料、疾病严重程度（急性生理与慢性健康状况评分系统（APACHE II）评分）、营养状况基线指标（主观全面评定法（SGA）和体重指数）、俯卧位和仰卧位期间营养供给的详细情况以及结局（住院时间和出院状态）。
51例患者符合纳入标准，其中4例因严重血流动力学不稳定未接受任何肠内营养而被排除在分析之外。患者的平均年龄为46.4±12.9岁，男女比例为7:3。入院时，SGA显示51%的患者存在中度营养不良，平均APACHE II评分为26.8±9.2。每位患者俯卧位通气的平均时长为60.2±30.7小时。所有患者均接受持续鼻胃管/口胃管喂养。仰卧位时规定的平均热量（千卡/千克/天）和蛋白质（克/千克/天）分别为24.5±3.8和1.1±0.2，而俯卧位时规定的平均热量和蛋白质分别为23.5±3.6和1.1±0.2。患者在仰卧位时摄入的规定热量百分比与俯卧位时相似（83.2%对79.6%；P=0.12）。与俯卧位相比，患者在仰卧位时摄入的规定蛋白质百分比更高（80.8%对75%，P=0.02）。仰卧位和俯卧位时摄入至少75%热量和蛋白质目标的患者比例分别为37例（78.7%）和37例（78.7%），以及32例（68.1%）和21例（44.6%）。
在接受俯卧位有创机械通气的危重症患者中，鼻胃管/口胃管喂养的肠内营养是可行的且耐受性良好。俯卧位时热量和蛋白质的营养供给与仰卧位相当。
