First Medical Department, Faculty of Medicine in Pilsen, Charles University and University Hospital in Pilsen, Pilsen, Czech Republic.
CHRU La Cavale Blanche, Brest, France.
Crit Care. 2022 May 18;26(1):143. doi: 10.1186/s13054-022-03997-z.
Medical nutrition therapy may be associated with clinical outcomes in critically ill patients with prolonged intensive care unit (ICU) stay. We wanted to assess nutrition practices in European intensive care units (ICU) and their importance for clinical outcomes.
Prospective multinational cohort study in patients staying in ICU ≥ 5 days with outcome recorded until day 90. Macronutrient intake from enteral and parenteral nutrition and non-nutritional sources during the first 15 days after ICU admission was compared with targets recommended by ESPEN guidelines. We modeled associations between three categories of daily calorie and protein intake (low: < 10 kcal/kg, < 0.8 g/kg; moderate: 10-20 kcal/kg, 0.8-1.2 g/kg, high: > 20 kcal/kg; > 1.2 g/kg) and the time-varying hazard rates of 90-day mortality or successful weaning from invasive mechanical ventilation (IMV).
A total of 1172 patients with median [Q1;Q3] APACHE II score of 18.5 [13.0;26.0] were included, and 24% died within 90 days. Median length of ICU stay was 10.0 [7.0;16.0] days, and 74% of patients could be weaned from invasive mechanical ventilation. Patients reached on average 83% [59;107] and 65% [41;91] of ESPEN calorie and protein recommended targets, respectively. Whereas specific reasons for ICU admission (especially respiratory diseases requiring IMV) were associated with higher intakes (estimate 2.43 [95% CI: 1.60;3.25] for calorie intake, 0.14 [0.09;0.20] for protein intake), a lack of nutrition on the preceding day was associated with lower calorie and protein intakes (- 2.74 [- 3.28; - 2.21] and - 0.12 [- 0.15; - 0.09], respectively). Compared to a lower intake, a daily moderate intake was associated with higher probability of successful weaning (for calories: maximum HR 4.59 [95% CI: 1.5;14.09] on day 12; for protein: maximum HR 2.60 [1.09;6.23] on day 12), and with a lower hazard of death (for calories only: minimum HR 0.15, [0.05;0.39] on day 19). There was no evidence that a high calorie or protein intake was associated with further outcome improvements.
Calorie intake was mainly provided according to the targets recommended by the active ESPEN guideline, but protein intake was lower. In patients staying in ICU ≥ 5 days, early moderate daily calorie and protein intakes were associated with improved clinical outcomes. Trial registration NCT04143503 , registered on October 25, 2019.
医学营养疗法可能与 ICU 住院时间延长的危重症患者的临床结局相关。我们旨在评估欧洲 ICU 的营养实践及其对临床结局的重要性。
对 ICU 入住时间≥5 天的患者进行前瞻性多国队列研究，并记录 90 天内的结局。入住 ICU 后第 15 天内，比较肠内和肠外营养以及非营养性来源的宏量营养素摄入量与 ESPEN 指南推荐的目标值。我们建立了三种每日热量和蛋白质摄入量（低：＜10kcal/kg，＜0.8g/kg；中：10-20kcal/kg，0.8-1.2g/kg，高：＞20kcal/kg，＞1.2g/kg）与 90 天死亡率或有创机械通气（IMV）成功脱机率的时间变化风险率之间的关联。
共纳入了 1172 名 APACHE II 评分中位数[四分位间距（Q1；Q3）]为 18.5[13.0；26.0]的患者，其中 24%在 90 天内死亡。ICU 住院时间中位数为 10.0[7.0；16.0]天，74%的患者可以成功脱机。患者平均达到了 83%[59；107]和 65%[41；91]ESPEN 热量和蛋白质推荐目标，分别。然而，入住 ICU 的具体原因（特别是需要 IMV 的呼吸系统疾病）与较高的摄入量相关（热量摄入量的估计值为 2.43[95%CI：1.60；3.25]，蛋白质摄入量为 0.14[0.09；0.20]），前一天缺乏营养与热量和蛋白质摄入量降低相关（分别为-2.74[-3.28；-2.21]和-0.12[-0.15；-0.09]）。与较低的摄入量相比，每天摄入适量的热量和蛋白质与更高的脱机成功率相关（对于热量：第 12 天的最大 HR 为 4.59[95%CI：1.5；14.09]；对于蛋白质：第 12 天的最大 HR 为 2.60[1.09；6.23]），与死亡率降低的风险相关（仅热量：第 19 天的最小 HR 为 0.15[0.05；0.39]）。没有证据表明高热量或高蛋白摄入与进一步的临床结局改善相关。
热量摄入主要根据 ESPEN 指南的推荐目标提供，但蛋白质摄入较低。在 ICU 入住≥5 天的患者中，早期适度的每日热量和蛋白质摄入与改善临床结局相关。
NCT04143503，于 2019 年 10 月 25 日注册。
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