背景:营养在危重病的恢复中起着至关重要的作用。在后重症监护病房(ICU)期间,患者通常会逐渐恢复口服营养。然而,对ICU后住院期间营养摄入量进行量化的研究很少,也缺乏正式指南.本研究旨在详细描述整个ICU后住院期间的能量和蛋白质摄入量,并探讨蛋白质摄入量与临床结果之间的关系。
方法:一项前瞻性观察性的单中心队列研究是对普通病房ICU后患者进行的,这些患者在ICU中至少入住72小时后接受(标准)肠内喂养≥24小时。每天使用食物订单行和剩饭的数字摄影来评估口服摄入量。其他数据,包括(标准)肠内营养的量,是从电子病历中收集的。主要结果是确定能量和蛋白质的摄入量,达到目标,在后ICU时期。此外,ICU出院后的住院时间,比较了是否符合蛋白质指标的患者的再入院率和死亡率.
结果:总计,包括48例患者。本研究分析了34例患者的完整营养数据,加起来总共有484个观察日,1681张照片和6634食品订单行。评估者之间的协议非常好(ICC0.878)。所有营养组的总体平均能量和蛋白质充足性为82.3%(SD18.3)和83.1%(SD19.8)。只有51.2%的研究参与者(n=21)在整个ICU病房住院期间达到了超过90%的规定蛋白质目标。在仅口服摄入的患者组中观察到最低摄入量(中位数蛋白质充足性为75.5%),而(补充)肠内营养(EN)的患者均满足其蛋白质目标的90%以上。规定的目标低于建议,规定的卡路里和蛋白质既没有订购也没有消耗。停用EN导致能量(44.1%)和蛋白质摄入量(50.7%)立即显著下降。随后,患者需要长达6天的时间才能再次达到蛋白质目标.没有观察到临床结果的差异。
结论:大多数患者在ICU后住院期间未达到能量和蛋白质指标。营养性能高度依赖于营养途径,并且在仅口服摄入的患者中最低(尽管有食物强化策略和/或口服营养补充剂)。在接受(补充)EN的患者中观察到最佳摄入量。然而,停止EN会立即带来营养风险。在这项研究中没有发现临床结果的差异。我们的发现强调需要进行后续研究,以缩小ICU后时期个性化营养支持的差距,以达到蛋白质和能量目标。
BACKGROUND: Nutrition plays an essential role in the recovery of critical illness. In the post-Intensive Care Unit (ICU) period, patients typically return to oral nutrition gradually. However, studies quantifying nutritional intake in the post-ICU hospitalization period are scarce and formal guidelines are lacking. This
study aims to describe energy and protein intake in detail over the entire post-ICU hospitalization period and explore associations between protein intake and clinical outcomes.
METHODS: A prospective observational single-center cohort
study was conducted amongst post-ICU patients in general wards after a minimum ICU-stay of 72 h and who received (par)enteral feeding for ≥24 h in the ICU. Oral intake was assessed daily using food order lines and digital photography of meal leftovers. Other data, including amounts of (par)enteral nutrition, were collected from electronic medical records. The primary outcome was to identify energy and protein intake, and reached targets, in the post-ICU period. In addition, length of hospital stay after ICU discharge, readmission and mortality rates were compared between patients meeting protein targets or not.
RESULTS: In total, 48 patients were included. Complete nutritional data of 34 patients were analyzed in the current study, adding up to a total number of 484 observational days, 1681 photos and 6634 food order lines. Inter-rater agreement was excellent (ICC 0.878). Overall mean energy and protein
adequacy for all nutritional groups was 82.3% (SD 18.3) and 83.1% (SD 19.8). Only 51.2% of the study participants (n = 21) reached overall >90% of prescribed protein targets during their entire post-ICU ward stay. The lowest intake was seen in the patient group with exclusively oral intake (median protein
adequacy 75.5%), whereas patients with (supplemental) enteral nutrition (EN) all met >90% of their protein targets. Prescribed targets were below recommendations, and prescribed calories and proteins were neither ordered nor consumed. Discontinuation of EN resulted in immediate marked drops in energy (44.1%) and protein intake (50.7%). Subsequently, patients needed up to six days to reach protein targets again. No differences in clinical outcomes were observed.
CONCLUSIONS: Most patients did not meet energy and protein targets in the post-ICU hospitalization period. Nutrition performance was highly dependent on the route of nutrition and was lowest among patients with oral intake only (despite of food fortification strategies and/or oral nutritional supplements). The best intake was observed in patients receiving (supplemental) EN. However, cessation of EN posed an immediate nutritional risk. No differences in clinical outcomes were found in this
study. Our findings stress the need for follow-up studies to close the gap with individualized nutritional support in the post-ICU period to reach protein and energy targets.