目的:早期报告提示重症COVID-19患者肠内喂养存在明显困难。这项研究旨在表征患病率,临床表现,和COVID-19危重患者喂养不耐受的结果。
方法:我们检查了2020年3月11日至6月28日在马萨诸塞州总医院重症监护病房(ICU)接受肠内营养的323例COVID-19成年患者。系统图表审查确定患病率,临床特征,和医院结果(ICU并发症,逗留时间,和死亡率)喂养不耐受。
结果:56%的患者出现喂养不耐受,最常见的表现为胃残留量大(83.9%),腹胀(67.2%),和呕吐(63.9%)。插管长度(OR1.05,95%CI1.03-1.08),表现≥1个GI症状(OR0.76,95%CI0.59-0.97),重度肥胖(OR0.29,95%CI0.13-0.66)与喂养不耐受的发生独立相关.与耐饲料患者相比,发生喂养不耐受的患者明显更容易患心脏病,肾,肝,以及住院期间的血液学并发症。喂养不耐受与不良结局相关,包括ICU住院时间延长(中位数[IQR]21.5[14-30]vs.15[9-22]天,P<0.001),总住院时间(中位数[IQR]30.5[19-42]vs.24[15-35],P<0.001)和住院死亡率(33.9%vs.16.1%,P<0.001)。喂养不耐受与死亡风险增加独立相关(HR3.32;95%CI1.97-5.6)。
结论:喂养不耐受是重症COVID-19患者在大型三级护理经验中经常遇到的并发症,并与不良预后相关。
Early reports suggest significant difficulty with enteral feeding in critically ill COVID-19 patients. This study aimed to characterize the prevalence, clinical manifestations, and outcomes of feeding intolerance in critically ill patients with COVID-19.
We examined 323 adult patients with COVID-19 admitted to the intensive care units (ICUs) of Massachusetts General Hospital between March 11 and June 28, 2020 who received enteral nutrition. Systematic chart review determined prevalence, clinical characteristics, and hospital outcomes (ICU complications, length of stay, and mortality) of feeding intolerance.
Feeding intolerance developed in 56% of the patients and most commonly manifested as large gastric residual volumes (83.9%), abdominal distension (67.2%), and vomiting (63.9%). Length of intubation (OR 1.05, 95% CI 1.03-1.08), ≥1 GI symptom on presentation (OR 0.76, 95% CI 0.59-0.97), and severe obesity (OR 0.29, 95% CI 0.13-0.66) were independently associated with development of feeding intolerance. Compared to feed-tolerant patients, patients with incident feeding intolerance were significantly more likely to suffer cardiac, renal, hepatic, and hematologic complications during their hospitalization. Feeding intolerance was similarly associated with poor outcomes including longer ICU stay (median [IQR] 21.5 [14-30] vs. 15 [9-22] days, P < 0.001), overall hospitalization time (median [IQR] 30.5 [19-42] vs. 24 [15-35], P < 0.001) and in-hospital mortality (33.9% vs. 16.1%, P < 0.001). Feeding intolerance was independently associated with an increased risk of death (HR 3.32; 95% CI 1.97-5.6).
Feeding intolerance is a frequently encountered complication in critically ill COVID-19 patients in a large tertiary care experience and is associated with poor outcomes.