Park Heemoon, Lim Sung Yoon, Kim Sebin, Kim Hyung-Sook, Kim Soyeon, Yoon Ho Il, Cho Young-Jae
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Acute Crit Care. 2022 Aug;37(3):382-390. doi: 10.4266/acc.2022.00220. Epub 2022 Jul 19.
Enteral nutrition (EN) supply within 48 hours after intensive care unit (ICU) admission improves clinical outcomes. The "new ICU evaluation & development of nutritional support protocol (NICE-NST)" was introduced in an ICU of tertiary academic hospital. This study showed that early EN through protocolized nutritional support would supply more nutrition to improve clinical outcomes.
This study screened 170 patients and 62 patients were finally enrolled; patients who were supplied nutrition without the protocol were classified as the control group (n=40), while those who were supplied according to the protocol were classified as the test group (n=22).
In the test group, EN started significantly earlier (3.7±0.4 days vs. 2.4±0.5 days, P=0.010). EN calorie (4.0±1.0 kcal/kg vs. 6.7±0.9 kcal/kg, P=0.006) and protein (0.17±0.04 g/kg vs. 0.32±0.04 g/kg, P=0.002) supplied were significantly higher in the test group. Although EN was supplied through continuous feeding in the test group, there was no difference in complications such as feeding hold due to excessive gastric residual volume or vomit, and hyper- or hypo-glycemia between the two groups. Hospital mortality was significantly lower in the group that started EN within 1.5 days (42.9% vs. 11.8%, P=0.018). The proportion of patients who started EN within 1.5 days was higher in the test group (40.9% vs. 17.5%, P=0.044).
The NICE-NST may improve EN supply and mortality of critically ill patients without increasing complications.
重症监护病房（ICU）入院后48小时内给予肠内营养（EN）可改善临床结局。一所三级学术医院的ICU引入了“新ICU营养支持方案评估与制定（NICE-NST）”。本研究表明，通过规范化营养支持进行早期EN可提供更多营养以改善临床结局。
本研究筛选了170例患者，最终纳入62例；未按照方案给予营养的患者被归为对照组（n = 40），而按照方案给予营养的患者被归为试验组（n = 22）。
试验组EN开始时间显著更早（3.7±0.4天 vs. 2.4±0.5天，P = 0.010）。试验组给予的EN热量（4.0±1.0千卡/千克 vs. 6.7±0.9千卡/千克，P = 0.006）和蛋白质（0.17±0.04克/千克 vs. 0.32±0.04克/千克，P = 0.002）显著更高。尽管试验组通过持续输注给予EN，但两组在因胃残余量过多或呕吐导致的喂养中断以及高血糖或低血糖等并发症方面无差异。在1.5天内开始EN的组中，医院死亡率显著更低（42.9% vs. 11.8%，P = 0.018）。试验组中在1.5天内开始EN的患者比例更高（40.9% vs. 17.5%，P = 0.044）。
NICE-NST可能改善重症患者的EN供给并降低死亡率，且不增加并发症。
