Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea.
Inter-Department of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea.
Nutrients. 2022 May 31;14(11):2318. doi: 10.3390/nu14112318.
The initial nutritional delivery policy for patients with sepsis admitted to the intensive care unit (ICU) has not been fully elucidated. We aimed to determine whether an initial adequate nutrition supply and route of nutrition delivery during the first week of sepsis onset improve clinical outcomes of critically ill patients with sepsis. We reviewed adult patients with sepsis and septic shock in the ICU in a single tertiary teaching hospital between 31 November 2013 and 20 May 2017. Poisson log-linear and Cox regressions were performed to assess the relationships between clinical outcomes and sex, modified nutrition risk in the critically ill score, sequential organ failure assessment score, route of nutrition delivery, acute physiology and chronic health evaluation score, and daily energy and protein delivery during the first week of sepsis onset. In total, 834 patients were included. Patients who had a higher protein intake during the first week of sepsis onset had a lower in-hospital mortality (adjusted hazard ratio (HR), 0.55; 95% confidence interval (CI), 0.39−0.78; p = 0.001). A higher energy intake was associated with a lower 30-day mortality (adjusted HR, 0.94; 95% CI, 0.90−0.98; p = 0.003). The route of nutrition delivery was not associated with 1-year mortality in the group which was underfed; however, in patients who met > 70% of their nutritional requirement, enteral feeding (EN) with supplemental parenteral nutrition (PN) was superior to only EN (p = 0.016) or PN (p = 0.042). In patients with sepsis and septic shock, a high daily average protein intake may lower in-hospital mortality, and a high energy intake may lower the 30-day mortality, especially in those with a high modified nutrition risk in the critically ill scores. In patients who receive adequate energy, EN with supplemental PN may be better than only EN or PN, but not in underfed patients.
在重症监护病房（ICU）收治的脓毒症患者中，初始营养供给策略尚未完全阐明。我们旨在确定脓毒症发病的最初一周内提供充足的初始营养支持和营养供给途径，是否能改善危重症脓毒症患者的临床结局。我们回顾了 2013 年 11 月 31 日至 2017 年 5 月 20 日期间在一家三级教学医院 ICU 中收治的成人脓毒症和脓毒性休克患者。采用泊松对数线性和 Cox 回归分析评估临床结局与性别、危重症患者改良营养风险评分、序贯器官衰竭评估评分、营养供给途径、急性生理学和慢性健康评估评分，以及脓毒症发病的最初一周内的每日能量和蛋白质供给之间的关系。共纳入 834 例患者。脓毒症发病的最初一周内蛋白质摄入较高的患者院内死亡率较低（校正危险比（HR），0.55；95%置信区间（CI），0.39-0.78；p = 0.001）。能量摄入较高与 30 天死亡率降低相关（校正 HR，0.94；95%CI，0.90-0.98；p = 0.003）。在未满足营养需求的患者中，营养供给途径与 1 年死亡率无关；然而，在满足>70%营养需求的患者中，肠内营养（EN）联合补充肠外营养（PN）优于仅 EN（p = 0.016）或 PN（p = 0.042）。对于脓毒症和脓毒性休克患者，高每日平均蛋白质摄入可能降低院内死亡率，高能量摄入可能降低 30 天死亡率，尤其是危重症患者改良营养风险评分较高的患者。在接受足够能量的患者中，EN 联合补充 PN 可能优于仅 EN 或 PN，但在未满足营养需求的患者中并非如此。
