尽管肠内营养(EN)是危重病患者的首选营养途径,EN并不总是能够提供最佳的营养供应,需要肠胃外营养(PN)。这与胃肠道(GI)并发症密切相关,胃肠功能障碍和疾病严重程度的特征。本研究的目的是调查与EN开始后需要PN相关的因素,以及与EN相关的使用和并发症。
在2018年4月至7月期间收治的38个西班牙重症监护病房(ICU)需要EN治疗的成年患者被纳入一项前瞻性观察性研究。分析了接受EN治疗的患者和开始EN后需要PN的患者的特征(即,临床,实验室和分数)。
■总共443名患者,43(9.7%)获得PN。三分之一(29.3%)的患者出现消化道并发症,在需要PN的人群中更常见(26%与60%,p=0.001)。在仅接受EN治疗的患者(n=400)和需要补充或全部PN的患者(n=43)之间,平均能量和蛋白质递送没有差异。血脂异常,血蛋白,和炎症标志物,如C反应蛋白,在那些需要PN的患者中显示。ICU入住时序贯器官衰竭评估(SOFA)(危险比[HR]:1.161,95%置信区间[CI]:1.053-1.281,p=0.003)和危重症患者营养风险(mNUTRIC)评分(HR:1.311,95%CI:1.098-1.565,p=0.003)在需要PN的人群中更高。在多变量分析中,更高的SOFA评分(HR:1.221,95%CI:1.057-1.410,p=0.007)和ICU入院时更高的甘油三酯水平(HR:1.004,95%CI:1.001-1.007,p=0.003)与需要PN的风险增加相关,而入住ICU时较高的白蛋白水平(HR:0.424,95%CI:0.210-0.687,p=0.016)与较低的PN需求相关.
■ICU入院时SOFA和营养相关实验室参数较高可能与开始EN治疗后需要PN相关。这可能与胃肠道并发症的发生率较高有关。胃肠道功能障碍的特征。
■ClinicalTrials.gov:NCT03634943。
UNASSIGNED: Despite enteral nutrition (EN) is the preferred route of nutrition in patients with critical illness, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. This is strongly associated with gastrointestinal (GI) complications, a feature of gastrointestinal dysfunction and disease severity. The aim of the present study was to investigate factors associated with the need of PN after start of EN, together with the use and complications associated with EN.
UNASSIGNED: Adult patients admitted to 38 Spanish intensive care units (ICUs) between April and July 2018, who needed EN therapy were included in a prospective observational study. The characteristics of EN-treated patients and those who required PN after start EN were analyzed (i.e., clinical, laboratory and scores).
UNASSIGNED: Of a total of 443 patients, 43 (9.7%) received PN. One-third (29.3%) of patients presented GI complications, which were more frequent among those needing PN (26% vs. 60%, p = 0.001). No differences regarding mean energy and protein delivery were found between patients treated only with EN (n = 400) and those needing supplementary or total PN (n = 43). Abnormalities in lipid profile, blood proteins, and inflammatory markers, such as C-Reactive Protein, were shown in those patients needing PN. Sequential Organ Failure Assessment (SOFA) on ICU admission (Hazard ratio [HR]:1.161, 95% confidence interval [CI]:1.053-1.281, p = 0.003) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR:1.311, 95% CI:1.098-1.565, p = 0.003) were higher among those who needed PN. In the multivariate analysis, higher SOFA score (HR:1.221, 95% CI:1.057-1.410, p = 0.007) and higher triglyceride levels on ICU admission (HR:1.004, 95% CI:1.001-1.007, p = 0.003) were associated with an increased risk for the need of PN, whereas higher albumin levels on ICU admission (HR:0.424, 95% CI:0.210-0.687, p = 0.016) was associated with lower need of PN.
UNASSIGNED: A higher SOFA and nutrition-related laboratory parameters on ICU admission may be associated with the need of PN after starting EN therapy. This may be related with a higher occurrence of GI complications, a feature of GI dysfunction.
UNASSIGNED: ClinicalTrials.gov: NCT03634943.