Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, Bart's Health NHS Trust, London, UK.
Critical Care and Perioperative Medicine Research Group, Queen Mary University of London, London, UK.
JPEN J Parenter Enteral Nutr. 2024 Feb;48(2):206-214. doi: 10.1002/jpen.2586. Epub 2023 Dec 31.
Patients experiencing persistent critical illness have poor short-term and long-term outcomes and consume disproportionate amounts of health care resources. Nutrition optimization may improve outcomes, though few data exist on resting energy expenditure and nutrition requirements. We hypothesized that increased energy surplus per day is associated with increased intensive care unit (ICU) length of stay (LoS) in critically ill patients.
Patients from a single ICU at Royal London Hospital were included in this retrospective cohort study.
energy surplus measured by serial indirect calorimetry (IC) and nutrition intake.
mechanical ventilation of ≥3 days and expected to remain ventilated.
ICU LoS.
Across 30 patients (median LoS 21 days), increased ICU LoS was associated with actual daily energy intake surplus to resting energy expenditure (REE) (R 0.16; P < 0.005). Median REE was less than predicted energy requirements: 24 kcal per day per kilogram of ideal body weight (IBW) (interquartile range [IQR], 20-28) vs 28 kcal/day/kg IBW (IQR, 26-29) (P < 0.001). Patients with COVID-19 had a median energy surplus (actual intake- REE) + 344 kcal/day (IQR 35-517) vs -57 kcal/day (IQR -324 to 211) in other patients (P = 0.011); however, they had a median LoS of 44 days (IQR 26-58) vs 10 days (IQR 7-24), respectively (P < 0.001). Patients with obesity had a median energy deficit of -32 kcal/day (IQR -384 to 335) vs +234 kcal/day (IQR -79 to 499) for nonobese patients (P = 0.021).
Overfeeding represents an easily modifiable factor to improve outcomes in patients experiencing persistent critical illness, for which IC may be useful.
持续处于危重状态的患者短期和长期预后较差，且消耗大量医疗资源。营养优化可能改善预后，但关于静息能量消耗和营养需求的数据很少。我们假设每天能量过剩与重症监护病房（ICU）入住时间（LoS）延长有关。
本回顾性队列研究纳入了伦敦皇家医院单一 ICU 的患者。
通过连续间接测热法（IC）和营养摄入来测量能量过剩。
机械通气时间≥3 天且预计需要持续通气。
ICU 入住时间。
在 30 名患者（中位 ICU 入住时间 21 天）中，ICU 入住时间延长与静息能量消耗（REE）的实际每日能量摄入过剩有关（R 0.16；P<0.005）。中位 REE 低于预测的能量需求：每天每公斤理想体重（IBW）24 千卡（四分位距 [IQR]，20-28）与每天 28 千卡/公斤 IBW（IQR，26-29）（P<0.001）。COVID-19 患者的能量过剩中位数（实际摄入量-REE）为+344 千卡/天（IQR 35-517），而其他患者为-57 千卡/天（IQR -324 至 211）（P=0.011）；然而，他们的中位 ICU 入住时间分别为 44 天（IQR 26-58）和 10 天（IQR 7-24）（P<0.001）。肥胖患者的能量不足中位数为-32 千卡/天（IQR -384 至 335），而非肥胖患者为+234 千卡/天（IQR -79 至 499）（P=0.021）。
过度喂养是改善持续处于危重状态患者预后的一个易于改变的因素，间接测热法可能对此有用。
