PDF(Pubmed)
Abstract：
Enteral nutrition (EN) therapy in ICU patients requiring oxygen therapy with high-flow nasal cannula (HFNC) and/or noninvasive mechanical ventilation (NIMV) is controversial. A prospective, cohort, observational, and multicenter study was conducted in 10 ICUs in Spain to analyze the 90-day mortality, tolerance, side effects, and infectious complications of trophic EN in patients requiring HFNC therapy and/or NIVM. A total of 149 patients were enrolled. The mean age, severity scores, tracheobronchitis, bacteremia, and antimicrobial therapy were significantly higher in deceased than in living patients (p < 0.05), and the mortality rate was 14.8%. A total of 110 patients received oral trophic feedings, 36 patients received nasogastric tube feedings (NGFs), and 3 received mixed feedings. Trophic EN was discontinued in only ten (14.9%) patients because of feeding-related complications. The variables selected for the multivariate logistic regression on feeding discontinuation were SOFA upon admission (OR per unit = 1.461) and urea (OR per mg/dL = 1.029). There were no significant differences in the development of new infections according to the route of EN administration. Early trophic feeding administered to patients with acute respiratory failure requiring noninvasive ventilation is safe and feasible, and is associated with few dietary and infectious complications in a mortality, setting comparable to similar studies.
摘要：
需要高流量鼻插管（HFNC）和/或非侵入性机械通气（NIMV）进行氧疗的ICU患者的肠内营养（EN）治疗存在争议。一个潜在的，队列,观察,在西班牙的10个ICU中进行了多中心研究，以分析90天的死亡率，容忍度,副作用,需要HFNC治疗和/或NIVM的患者营养EN的感染并发症。共纳入149例患者。平均年龄,严重性评分,气管支气管炎,菌血症,死亡患者的抗菌治疗明显高于存活患者(p<0.05)，死亡率为14.8%。共有110名病人接受了口腔营养喂养,36例患者接受鼻胃管喂养（NGFs），3人接受混合喂养。由于进食相关并发症，仅有10例（14.9％）患者停止了营养性EN。在停止进食的多变量逻辑回归中选择的变量是入院时的SOFA（每单位OR=1.461）和尿素（OR/mg/dL=1.029）。根据EN给药途径，新感染的发展没有显着差异。对需要无创通气的急性呼吸衰竭患者进行早期营养喂养是安全可行的，并且与死亡率的饮食和感染并发症有关，设置与类似研究相当。
