Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Clin Nutr ESPEN. 2021 Dec;46:532-538. doi: 10.1016/j.clnesp.2021.08.007. Epub 2021 Sep 9.
European and North American guidelines on Parenteral Nutrition (PN) and large Randomized Controlled Trials give divergent advices on nutritional therapeutic strategies for critically ill patients. We therefore investigated differences in therapeutic strategies of clinicians between European and Non-European Intensive Care Units (ICU) regarding start day of PN, preferred route of administration and prescription of total energy targets over the years.
In this study 16,032 patients from 1389 different ICUs were included. Data collection was performed in 28 different European and Non-European ICUs from 2007 to 2018 via nutritionDay, a worldwide-standardized one-day multinational cross-sectional audit.
In this analysis an abrupt delay in PN start days was observed in 2011 (7.64 days (4.31; 19.97); p = 0.001) and 2012 (6.41 days (3.1; 9.72); p = 0.001), which was significantly reversed within the following years until 2018. In European, compared to Non-European countries PN prescription was increased (27% versus 13%). Patients from North-America received significantly less kcal per day compared to Europe (-4.3 kcal kg (-6.9; -1.6); p = 0.001).
Our study provides further evidence on transatlantic discrepancies in nutritional therapy of ICU patients. Regular audits, such as nutritionDay are substantial for self-reflection of clinical daily practice of intensivists. It is time for worldwide consensus in nutritional therapy by developing worldwide guidelines and supporting standardization in nutrition care of critically ill patients.
欧洲和北美的肠外营养（PN）指南和大型随机对照试验对危重症患者的营养治疗策略给出了不同的建议。因此，我们研究了欧洲和非欧洲重症监护病房（ICU）的临床医生在 PN 起始日、首选给药途径和总能量目标处方方面的治疗策略差异。
本研究纳入了来自 1389 个不同 ICU 的 16032 名患者。数据收集于 2007 年至 2018 年通过营养日（nutritionDay）在 28 个不同的欧洲和非欧洲 ICU 中进行，这是一项全球性标准化的单日多国横断面审计。
在本分析中，我们观察到 PN 起始日在 2011 年（7.64 天（4.31；19.97）；p=0.001）和 2012 年（6.41 天（3.1；9.72）；p=0.001）急剧延迟，随后在接下来的几年中得到显著逆转。与非欧洲国家相比，欧洲国家的 PN 处方增加（27%比 13%）。与欧洲相比，来自北美的患者每天接受的热量明显减少（-4.3 千卡/公斤（-6.9；-1.6）；p=0.001）。
我们的研究提供了更多关于 ICU 患者营养治疗跨大西洋差异的证据。营养日等定期审核对于强化治疗师临床日常实践的自我反思非常重要。现在是通过制定全球指南和支持危重病患者营养护理的标准化来实现全球营养治疗共识的时候了。
