Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
Dietetics and Nutrition, The Alfred, Melbourne, Victoria, Australia.
J Hum Nutr Diet. 2025 Feb;38(1):e13385. doi: 10.1111/jhn.13385.
Energy and protein provision for critically ill patients who receive oral nutrition often falls below recommended targets. We compared characteristics and nutrition processes during hospital stay (within and post-intensive care unit [ICU] stay) of those who received oral nutrition as the sole nutrition source to those who first commenced enteral (EN) or parenteral nutrition (PN) within an Australian or New Zealand (ANZ) ICU.
Multicentre, observational study of routine nutrition care in 44 hospitals across ANZ, including adult patients within ICU admitted for at least 48 h. Those receiving oral nutrition as the sole source of nutrition (with or without oral nutrition supplements) were included in the 'oral nutrition' group and those who first received EN and/or PN in the ICU as the 'EN/PN group'. The primary outcome was median daily energy delivery in ICU. Data are presented as number (%) or median [interquartile range].
Of the 409 patients enroled, median [IQR] age was 64 [51-74] years and 257 patients (62%) were male. APACHE II score, use of invasive ventilation and hospital length of stay (LOS) were all lower in those receiving oral nutrition (n = 200) compared to those receiving EN/PN (n = 209). In ICU, 63 (31.5%) and 169 (81%) (p < 0.001), patients who were receiving oral nutrition and in the EN/PN group received a nutrition assessment, respectively. Oral nutrition supplements were provided for 40 (20%) patients in the oral nutrition group and 31 of 94 (33%) of those receiving oral nutrition in the EN/PN group (p = 0.019). Energy and protein intake in ICU for the oral nutrition group was 716 [597-1069] kcal/day and 37 [19-46] g/day versus 1158 [664-1583] kcal/day and 57 [31-77] g/day for those receiving EN/PN (p = 0.020 energy, p = 0.016 protein). Quantification of oral nutrition was attempted in 78/294 (27%) patients in ICU and completed on 27/78 (36%) occasions. On the ward, attempts were made for 120/273 (44%) patients, with 60/120 (50%) complete.
Patients who received oral nutrition as the sole nutrition source in ICU had lower illness severity, rates of nutrition assessment and provision of oral supplements compared to those who first received EN/PN. Quantification of oral nutrition was often incomplete for all patients in ICU and on the ward.
接受口服营养的危重症患者的能量和蛋白质供给常常低于推荐目标。我们比较了在澳大利亚或新西兰（ANZ）重症监护病房（ICU）中接受口服营养作为唯一营养来源的患者和首先开始肠内（EN）或肠外（PN）营养的患者在住院期间（ICU 内和 ICU 后）的特征和营养过程。
在 ANZ 的 44 家医院进行了一项多中心、观察性研究，纳入了至少住院 48 小时的 ICU 内成人患者。接受口服营养（含或不含口服营养补充剂）作为唯一营养来源的患者被纳入“口服营养”组，首先在 ICU 接受 EN 和/或 PN 的患者被纳入“EN/PN”组。主要结局是 ICU 内的中位每日能量供给。数据以数字（%）或中位数[四分位数范围]表示。
在纳入的 409 名患者中，中位[IQR]年龄为 64[51-74]岁，257 名患者（62%）为男性。与接受 EN/PN 的患者（n=209）相比，接受口服营养的患者（n=200）的急性生理和慢性健康状况评分 II（APACHE II）评分、有创通气的使用和住院时间（LOS）均较低。在 ICU 中，分别有 63（31.5%）和 169（81%）（p<0.001）名接受口服营养和 EN/PN 组的患者接受了营养评估。在口服营养组中，有 40 名（20%）患者接受了口服营养补充剂，而在 EN/PN 组中，有 31 名（33%）接受口服营养的患者接受了口服营养补充剂（p=0.019）。口服营养组 ICU 内的能量和蛋白质摄入量分别为 716[597-1069]kcal/天和 37[19-46]g/天，而接受 EN/PN 的患者分别为 1158[664-1583]kcal/天和 57[31-77]g/天（p=0.020 能量，p=0.016 蛋白质）。在 ICU 中，有 78/294（27%）名患者尝试了口服营养的量化，其中 27/78（36%）例次完成了量化。在病房中，有 120/273（44%）名患者尝试了量化，其中 60/120（50%）例次完成了量化。
与首先接受 EN/PN 的患者相比，在 ICU 中仅接受口服营养作为唯一营养来源的患者疾病严重程度较低，接受营养评估和提供口服补充剂的比例也较低。在 ICU 和病房中，对所有患者的口服营养量化通常都不完整。
