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影响重症监护病房成年危重症患者机械通气持续时间的最佳营养因素

Optimal Nutritional Factors Influencing the Duration of Mechanical Ventilation Among Adult Patients with Critical Illnesses in an Intensive Care Unit.

作者信息

Koontalay Apinya, Suksatan Wanich, Sadang Jonaid M, Prabsangob Kantapong

机构信息

Independent Researcher, Melbourne, VIC, Australia.

Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.

出版信息

J Multidiscip Healthc. 2021 Jun 10;14:1385-1393. doi: 10.2147/JMDH.S319553. eCollection 2021.

Abstract

OBJECTIVE

This study aims to identify the impact of nutritional factors on mechanical ventilation duration for critical patients.

PATIENTS AND METHODS

The current study was a single-center, prospective observational design which enrolled one-hundred critically ill patients who were admitted to an intensive care unit (ICU). It demonstrates purposive sampling and also performs the descriptive nutritional factors influencing the mechanical ventilation duration. Daily calories target requirement scale (DCRS), subjective global assessment form (SGA), dyspnea assessment form, and APACHE II have been used as methods in the study along with time to initial enteral nutrition (EN) after 24-hour admission and daily calories target requirement over 7 days to assess patients. Data is analyzed using the multiple regressions.

RESULTS

As a result, nutritional status monitoring, time to initial EN, calories and target requirements are statistically positive significance associated with the mechanical ventilation duration respectively (R = 0.54, R = 0.30, R= 0.40, p < 0.05). However, age, illness severity, and dyspnea scales are not associated with the mechanical ventilation duration (p> 0.05). Therefore, the nutritional status, malnutrition scores and calorie target requirements can be used to significantly predict the mechanical ventilation duration. The predictive power is 58 and 28.0% of variance. The most proper influencer to predict the mechanical ventilation duration is nutritional status or malnutrition scores.

CONCLUSION

The research findings show that the nutritional status, time to initial EN, and calorie target requirement within 7 days of admission are associated with the mechanical ventilation duration in the critical patients. Therefore, it can be used to develop guidelines reducing the mechanical ventilation duration and to promote the ventilator halting for critical patients.

摘要

目的

本研究旨在确定营养因素对危重症患者机械通气时间的影响。

患者与方法

本研究为单中心前瞻性观察性设计,纳入了100名入住重症监护病房(ICU)的危重症患者。研究采用了目的抽样法,并对影响机械通气时间的营养因素进行了描述性分析。研究中使用了每日热量目标需求量表(DCRS)、主观全面评定表(SGA)、呼吸困难评定表和急性生理与慢性健康状况评分系统II(APACHE II),同时还记录了入院24小时后开始肠内营养(EN)的时间以及7天内的每日热量目标需求,以评估患者情况。数据采用多元回归分析。

结果

结果显示,营养状况监测、开始EN的时间、热量及目标需求与机械通气时间分别具有统计学上的显著正相关(R = 0.54,R = 0.30,R = 0.40,p < 0.05)。然而,年龄、疾病严重程度和呼吸困难量表与机械通气时间无关(p > 0.05)。因此,营养状况、营养不良评分和热量目标需求可用于显著预测机械通气时间。预测能力为方差的58%和28.0%。预测机械通气时间的最主要影响因素是营养状况或营养不良评分。

结论

研究结果表明,入院时的营养状况、开始EN的时间以及7天内的热量目标需求与危重症患者的机械通气时间相关。因此,可据此制定减少机械通气时间的指南,促进危重症患者撤机。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5c84/8203270/8a94dd69b423/JMDH-14-1385-g0001.jpg

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