Pettignano R, Heard M, Davis R, Labuz M, Hart M
Division of Critical Care Medicine, Egleston Children's Hospital at Emory University, Atlanta, GA 30322, USA.
Crit Care Med. 1998 Feb;26(2):358-63. doi: 10.1097/00003246-199802000-00041.
To evaluate the adequacy, tolerance, and complications of enteral nutrition, compared with parenteral nutrition, in pediatric patients requiring extracorporeal membrane oxygenation (ECMO).
A retrospective chart review of all patients placed on extracorporeal life support from January 1991 through December 1995.
Medical/surgical pediatric intensive care unit at Egleston Children's Hospital, a tertiary care pediatric center.
Twenty-nine consecutive pediatric patients who required ECMO and were provided nutritional support, either enterally or parenterally. Group A consisted of 14 patients who were provided nutritional support using total parenteral nutrition. Group B consisted of 15 patients. Two patients were excluded from group B because their ECMO run was <36 hrs, leaving insufficient data for analysis. The remaining 13 patients were provided total enteral nutrition during ECMO.
None.
Both groups were similar in age, weight, pre-ECMO oxygenation index, alveolar-arterial oxygen difference, type, and duration of ECMO (p = NS). Comparison of percent ideal body weight on admission did not show a statistical difference between groups A and B (p = .883). There was no difference between the two groups in the time needed to achieve caloric goal (p = .536) from the initiation of ECMO. No complications were associated with the utilization of enteral feedings. Savings for the nutritional supplement was estimated to be $170 per day for the enterally fed group. The percentage of patients surviving was higher in the enterally fed patients compared with the parenterally fed group (79% vs. 100%), although this difference was not statistically significant (p = .47).
Enteral nutrition in patients receiving either venoarterial or venovenous ECMO is well tolerated, provides adequate nutrition, is cost effective, and is without complications, as compared with parenteral nutrition. These data suggest that total enteral nutrition can be safely administered for nutritional support in pediatric patients undergoing either venoarterial or venovenous ECMO.
比较肠内营养与肠外营养在需要体外膜肺氧合（ECMO）的儿科患者中的充足性、耐受性及并发症情况。
对1991年1月至1995年12月期间所有接受体外生命支持的患者进行回顾性病历审查。
三级儿科中心埃格尔斯顿儿童医院的内科/外科儿科重症监护病房。
29例连续需要ECMO并接受肠内或肠外营养支持的儿科患者。A组由14例接受全肠外营养支持的患者组成。B组由15例患者组成。B组中有2例患者因ECMO运行时间<36小时被排除，导致分析数据不足。其余13例患者在ECMO期间接受全肠内营养。
无。
两组在年龄、体重、ECMO前氧合指数、肺泡-动脉氧分压差、ECMO类型及持续时间方面相似（p =无显著差异）。入院时理想体重百分比的比较在A组和B组之间未显示出统计学差异（p = 0.883）。从开始ECMO到达到热量目标所需时间在两组之间无差异（p = 0.536）。肠内喂养未出现并发症。肠内喂养组的营养补充费用估计每天节省170美元。肠内喂养患者的存活百分比高于肠外喂养组（79%对100%），尽管这种差异无统计学意义（p = 0.47）。
与肠外营养相比，接受静脉-动脉或静脉-静脉ECMO的患者进行肠内营养耐受性良好，能提供充足营养，具有成本效益且无并发症。这些数据表明，全肠内营养可安全用于接受静脉-动脉或静脉-静脉ECMO的儿科患者的营养支持。
