Elmezoughi E, de Vasconcellos K
Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
South Afr J Crit Care. 2020 Jul 30;36(1). doi: 10.7196/SAJCC.2020.v36i1.412. eCollection 2020.
Adequate nutritional support is crucial to optimising intensive care unit (ICU) outcomes.
To assess adherence to current nutritional guidelines in critically ill patients in South Africa (SA). To identify risk factors for non-adherence to guideline.
Retrospective observational chart review of nutritional practices, from 1 December 2017 to 31 May 2018, during the first week of ICU admission in adult patients admitted to a tertiary, multidisciplinary ICU in Durban, SA, for >48 hours.
The study cohort (N=150) had a median age of 39 years and an ICU mortality of 28%. Surgical patients accounted for 50.7% of admissions. Ninety-eight percent of patients received mechanical ventilation, 75% required inotropic support, and 56% had acute kidney injury. The median time to initiation of enteral nutrition (EN) was 3 days, with EN being initiated within 48 hours in 39% of patients, and by day 7 80% of patients had received EN. Goal feeds were reached in 23% of patients by discharge, death or day 7. Parenteral nutrition was initiated in 16.7% of patients. There was an association between shock, acute kidney injury, increasing sequential organ failure assessment score and inotrope dose, and failure to initiate EN. Failure to initiate EN was predominantly due to unavoidable factors, but a number of clinical and administrative areas were identified to improve EN delivery.
Adequate nutrition is associated with reduced morbidity, ICU length of stay, mortality and improved functional outcomes. More attention to avoiding barriers to adequate ICU nutrition and enhanced adherence to feeding protocols should be encouraged.
This study significantly adds to the limited data available from sub- Saharan Africa on nutritional practices in critical care, and in particular barriers to provision of EN. It is further anticipated that the findings of the study will contribute in making recommendations in an attempt to improve the outcomes.
充足的营养支持对于优化重症监护病房（ICU）的治疗效果至关重要。
评估南非（SA）危重症患者对当前营养指南的依从性。识别不依从指南的风险因素。
对2017年12月1日至2018年5月31日期间，入住南非德班一家三级多学科ICU且入住时间超过48小时的成年患者，在其入住ICU的第一周进行营养实践的回顾性观察图表审查。
研究队列（N = 150）的中位年龄为39岁，ICU死亡率为28%。外科患者占入院患者的50.7%。98%的患者接受机械通气，75%需要血管活性药物支持，56%患有急性肾损伤。肠内营养（EN）开始的中位时间为3天，39%的患者在48小时内开始EN，到第7天80%的患者接受了EN。出院、死亡或第7天时，23%的患者达到目标喂养量。16.7%的患者开始接受肠外营养。休克、急性肾损伤、序贯器官衰竭评估评分增加和血管活性药物剂量与未开始EN之间存在关联。未开始EN主要是由于不可避免的因素，但已确定一些临床和管理领域以改善EN的提供。
充足的营养与发病率降低、ICU住院时间缩短、死亡率降低及功能结局改善相关。应鼓励更多关注避免充足的ICU营养的障碍，并加强对喂养方案的依从性。
本研究显著增加了撒哈拉以南非洲关于重症监护营养实践，特别是EN提供障碍的有限数据。进一步预计该研究结果将有助于提出改进结局的建议。
