Division of Critical Care Medicine, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, USA; Harvard Medical School, Boston, MA, USA; Perioperative and Critical Care - Center for Outcomes Research (PC-CORE), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
Clin Nutr. 2022 Dec;41(12):2621-2627. doi: 10.1016/j.clnu.2022.09.018. Epub 2022 Oct 5.
BACKGROUND & AIMS: Intermittent enteral nutrition (EN) may have physiologic benefits over continuous feeding in critical illness. We aimed to compare nutrition and infection outcomes in critically ill children receiving intermittent or continuous EN.
International, multi-center prospective observational study of mechanically ventilated children, 1 month to 18 years of age, receiving EN. Percent energy or protein adequacy (energy or protein delivered/prescribed × 100) and acquired infection rates were compared between intermittent and continuous EN groups using adjusted-multivariable and 4:1 propensity-score matched (PSM) analyses. Sensitivity analyses were performed after excluding patients who crossed over between intermittent and continuous EN.
1375 eligible patients from 66 PICUs were included. Patients receiving continuous EN (N = 1093) had a higher prevalence of respiratory illness and obesity, and lower prevalence of neurologic illness and underweight status on admission, compared to those on intermittent EN (N = 282). Percent energy or protein adequacy, proportion of patients who achieved 60% of energy or protein adequacy in the first 7 days of admission, and rates of acquired infection were not different between the 2 groups in adjusted-multivariable and propensity score matching analyses (P > 0.05).
Intermittent versus continuous EN strategy is not associated with differences in energy or protein adequacy, or acquired infections, in mechanically ventilated, critically ill children. Until further evidence is available, an individualized feeding strategy rather than a universal approach may be appropriate.
间断性肠内营养（EN）相较于连续性喂养在危重症患者中可能具有更好的生理学获益。本研究旨在比较间断性 EN 与连续性 EN 用于危重症儿童时的营养和感染结局。
这是一项国际性、多中心、前瞻性观察性研究，纳入了机械通气的儿童（1 个月至 18 岁），并给予肠内营养。使用调整后的多变量分析和 4:1 倾向评分匹配（PSM）分析，比较间断性 EN 与连续性 EN 组间的能量或蛋白质达标率（实际提供的能量或蛋白质/规定的能量或蛋白质×100）和获得性感染率。在排除了从间断性 EN 转为连续性 EN 的患者后，进行了敏感性分析。
纳入了来自 66 个 PICUs 的 1375 名符合条件的患者。与接受间断性 EN 的患者（N=282）相比，接受连续性 EN 的患者（N=1093）入院时患有呼吸疾病和肥胖症的比例更高，而患有神经系统疾病和体重不足的比例更低。在调整后的多变量分析和 PSM 分析中，2 组间的能量或蛋白质达标率、在入院后 7 天内达到 60%能量或蛋白质达标率的患者比例以及获得性感染率均无差异（P>0.05）。
在机械通气的危重症儿童中，间断性 EN 与连续性 EN 策略在能量或蛋白质达标率或获得性感染方面没有差异。在进一步的证据出现之前，个体化的喂养策略可能比通用方法更为合适。
