Lopez-Delgado Juan Carlos, Servia-Goixart Lluís, Grau-Carmona Teodoro, Bordeje-Laguna Luisa, Portugal-Rodriguez Esther, Lorencio-Cardenas Carolina, Vera-Artazcoz Paula, Macaya-Redin Laura, Martinez-Carmona Juan Francisco, Marin Corral Judith, Flordelís-Lasierra Jose Luis, Seron-Arbeloa Carlos, Alcazar-Espin Maravillas de Las Nieves, Navas-Moya Elisabeth, Aldunate-Calvo Sara, Nieto Martino Beatriz, Martinez de Lagran Itziar
Hospital Clinic of Barcelona, Barcelona, Spain.
Departament d'Infermeria Fonamental i Médico-Quirúrgica, School of Nursing, University of Barcelona, Barcelona, Spain.
Front Nutr. 2023 Aug 24;10:1250305. doi: 10.3389/fnut.2023.1250305. eCollection 2023.
Despite enteral nutrition (EN) is the preferred route of nutrition in patients with critical illness, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. This is strongly associated with gastrointestinal (GI) complications, a feature of gastrointestinal dysfunction and disease severity. The aim of the present study was to investigate factors associated with the need of PN after start of EN, together with the use and complications associated with EN.
Adult patients admitted to 38 Spanish intensive care units (ICUs) between April and July 2018, who needed EN therapy were included in a prospective observational study. The characteristics of EN-treated patients and those who required PN after start EN were analyzed (i.e., clinical, laboratory and scores).
Of a total of 443 patients, 43 (9.7%) received PN. One-third (29.3%) of patients presented GI complications, which were more frequent among those needing PN (26% vs. 60%, = 0.001). No differences regarding mean energy and protein delivery were found between patients treated only with EN ( = 400) and those needing supplementary or total PN ( = 43). Abnormalities in lipid profile, blood proteins, and inflammatory markers, such as C-Reactive Protein, were shown in those patients needing PN. Sequential Organ Failure Assessment (SOFA) on ICU admission (Hazard ratio [HR]:1.161, 95% confidence interval [CI]:1.053-1.281, = 0.003) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR:1.311, 95% CI:1.098-1.565, = 0.003) were higher among those who needed PN. In the multivariate analysis, higher SOFA score (HR:1.221, 95% CI:1.057-1.410, = 0.007) and higher triglyceride levels on ICU admission (HR:1.004, 95% CI:1.001-1.007, = 0.003) were associated with an increased risk for the need of PN, whereas higher albumin levels on ICU admission (HR:0.424, 95% CI:0.210-0.687, = 0.016) was associated with lower need of PN.
A higher SOFA and nutrition-related laboratory parameters on ICU admission may be associated with the need of PN after starting EN therapy. This may be related with a higher occurrence of GI complications, a feature of GI dysfunction.
ClinicalTrials.gov: NCT03634943.
尽管肠内营养（EN）是危重症患者首选的营养支持途径，但EN并不总能提供最佳的营养供给，此时就需要肠外营养（PN）。这与胃肠道（GI）并发症密切相关，而胃肠道并发症是胃肠功能障碍和疾病严重程度的一个特征。本研究的目的是调查EN开始后需要PN的相关因素，以及EN的使用情况和相关并发症。
纳入2018年4月至7月期间入住38家西班牙重症监护病房（ICU）且需要EN治疗的成年患者，进行一项前瞻性观察研究。分析接受EN治疗的患者以及开始EN治疗后需要PN的患者的特征（即临床、实验室和评分指标）。
在总共443例患者中，43例（9.7%）接受了PN。三分之一（29.3%）的患者出现了GI并发症，在需要PN的患者中更为常见（26%对60%，P = 0.001）。仅接受EN治疗的患者（n = 400）与需要补充性或全量PN的患者（n = 43）在平均能量和蛋白质供给方面未发现差异。需要PN的患者出现了血脂、血液蛋白质以及炎症标志物（如C反应蛋白）异常。入住ICU时的序贯器官衰竭评估（SOFA）（风险比[HR]：1.161，95%置信区间[CI]：1.053 - 1.281，P = 0.003）和改良的危重症营养风险（mNUTRIC）评分（HR：1.311，95% CI：1.098 - 1.565，P = 0.003）在需要PN的患者中更高。在多变量分析中，较高的SOFA评分（HR：1.221，95% CI：1.057 - 1.410，P = 0.007）和入住ICU时较高的甘油三酯水平（HR：1.004，95% CI：1.001 - 1.007，P = 0.003）与需要PN的风险增加相关，而入住ICU时较高的白蛋白水平（HR：0.424，95% CI：0.210 - 0.687，P = 0.016）与较低的PN需求相关。
入住ICU时较高的SOFA评分和与营养相关的实验室参数可能与EN治疗开始后需要PN有关。这可能与较高的GI并发症发生率有关，而GI并发症是胃肠功能障碍的一个特征。
ClinicalTrials.gov：NCT03634943。
