Viner Smith Elizabeth, Lange Kylie, Peake Sandra, Chapman Marianne J, Ridley Emma J, Rayner Christopher K, Chapple Lee-Anne S
Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
JPEN J Parenter Enteral Nutr. 2025 Feb;49(2):214-221. doi: 10.1002/jpen.2717. Epub 2024 Dec 20.
Limited literature exists on nutrition practices for long-stay patients in the intensive care unit (ICU). We aimed to compare nutrition practices in the first and second weeks of an ICU admission.
A post hoc exploratory analysis of The Augmented vs Routine Approach to Giving Energy Trial (TARGET) randomized controlled trial (RCT) was undertaken. Inclusion criteria were: enrolled in TARGET on day 1 or 2 of ICU admission and ICU length of stay (LOS) >14 days. Clinical characteristics are described, and nutrition delivery and management compared between days 1-7 and 8-14. Data are n (%), mean ± SD, median (interquartile range [IQR]), or mean difference (MD) and 95% confidence interval (95% CI), with P < 0.05 considered significant.
Data from 664 patients were analyzed (56.2 ± 16.3 years; 61% male; body mass index 29.2 ± 7.5 kg/m and APACHE II 21.9 ± 8.1). When comparing days 1-7 to 8-14: (1) energy delivery was greater (all sources: 1826 ± 603 vs 1729 ± 689 (MD: 97 [95% CI: 52-140] kcal/day, P < 0.001) and nonnutrition sources: 317 ± 230 vs 192 ± 197 (MD 125 [95% CI: 111-139] kcal/day; P < 0.001); (2) protein delivery was similar (66 ± 20 vs 68 ± 24 (MD: -1.4 [95% CI: -3.2 to 0.4] g/day; P = 0.125]); and (3) fewer patients received parenteral nutrition (PN) (5% vs 9%, P < 0.001) or small intestine feeding (3% vs 8%; P < 0.001).
In this post hoc analysis, patients with an ICU LOS >14 days had greater energy delivery and fewer patients received PN or small intestine feeding during days 1-7 than days 8-14. Uncertainty remains regarding whether these data reflect usual practice and the clinical implications of this.
关于重症监护病房（ICU）长期住院患者营养实践的文献有限。我们旨在比较ICU入院第一周和第二周的营养实践情况。
对强化能量供给与常规能量供给试验（TARGET）随机对照试验（RCT）进行事后探索性分析。纳入标准为：在ICU入院第1天或第2天入选TARGET且ICU住院时间（LOS）>14天。描述临床特征，并比较第1 - 7天和第8 - 14天的营养供给和管理情况。数据以n（%）、均值±标准差、中位数（四分位间距[IQR]）或均值差（MD）及95%置信区间（95%CI）表示，P<0.05认为具有统计学意义。
分析了664例患者的数据（年龄56.2±16.3岁；男性占61%；体重指数29.2±7.5kg/m²，急性生理与慢性健康状况评分系统II（APACHE II）评分为21.9±8.1）。比较第1 - 7天和第8 - 14天：（1）能量供给更高（所有来源：1826±603 vs 1729±689（MD：97[95%CI：52 - 140]kcal/天，P<0.001））以及非营养来源：317±230 vs 192±197（MD 125[95%CI：111 - 139]kcal/天；P<0.001）；（2）蛋白质供给相似（66±20 vs 68±24（MD： - 1.4[95%CI： - 3.2至0.4]g/天；P = 0.125））；（3）接受肠外营养（PN）的患者更少（5% vs 9%，P<0.001）或小肠喂养的患者更少（3% vs 8%；P<0.001）。
在这项事后分析中，ICU住院时间>14天的患者在第1 - 7天比第8 - 14天能量供给更高，接受PN或小肠喂养的患者更少。这些数据是否反映常规实践及其临床意义仍不确定。
