Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol
Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol
复制标题
DOI：
10.1378/chest.125.4.1446
复制
发表时间：
2004-04-01
期刊：
影响因子：
9.6
通讯作者：
Gould, MK
中科院分区：
文献类型：
--
作者：
Barr, J;Hecht, M;Gould, MK
目的：确定在 ICU 中实施营养管理方案是否会增加肠内营养的使用、早期喂养并改善患者的临床结果。设计：在引入 ICU 提供营养支持的循证指南之前和之后对危重患者进行前瞻性评估。地点：两家教学医院的内外科 ICU。患者：200 名入院 ICU 后仍保持 NPO > 48 小时的危重成年患者。实施前组纳入 100 名患者，实施后组纳入 100 名患者。 干预：实施基于证据的 ICU 营养管理方案。 测量和结果：营养结果测量包括接受肠内营养的患者数量、开始营养支持的时间以及营养支持第 4 天给予的热量目标百分比。临床结果包括机械通气时间、ICU 和住院时间 (LOS) 以及院内死亡率。实施后组的患者通过肠内途径喂养的频率更高（分别为 78% 和 68%；p = 0.08），在调整疾病严重程度、基线营养状况和其他因素后，这种差异具有统计学意义（比值比，2.4；95% 置信区间 [CI]，1.2 至 5.0；p = 0.009）。各组之间的喂养时间和营养支持第 4 天的热量摄入没有差异。实施后组机械通气的平均 (+/-SD) 持续时间较短（分别为 17.9 +/- 31.3 天与 11.2 +/- 19.5 天；p = 0.11），并且在调整年龄、性别、疾病严重程度、入院类型、基线营养状况和营养支持类型后，这种差异具有统计学意义（p = 0.03）。两组之间的 ICU 或医院 LOS 没有差异。接受肠内营养的患者死亡风险降低了 56%（风险比，0.44；95% CI，0.24 至 0.80；p = 0.007）。结论：基于证据的营养管理方案增加了 ICU 患者接受肠内营养的可能性，并缩短了机械通气的持续时间。在这些研究的患者中，肠内营养与死亡风险降低相关。
Objective: To determine whether the implementation of a nutritional management protocol in the ICU leads to the increased use of enteral nutrition, earlier feeding, and improved clinical outcomes in patients.Design: Prospective evaluation of critically ill patients before and after the introduction of an evidence-based guideline for providing nutritional support in the ICU.Setting: The medical-surgical ICUs of two teaching hospitals.Patients: Two hundred critically ill adult patients who remained npo > 48 h after their admission to the ICU. One hundred patients were enrolled into the preimplementation group, and 100 patients were enrolled in the postimplementation group.Intervention: Implementation of an evidence-based ICU nutritional management protocol.Measurement and results: Nutritional outcome measures included the number of patients who received enteral nutrition, the time to initiate nutritional support, and the percent caloric target administered on day 4 of nutritional support. Clinical outcomes included the duration of mechanical ventilation, ICU and in-hospital length of stay (LOS), and in-hospital mortality rates. Patients in the postimplementation group were fed more frequently via the enteral route (78% vs 68%, respectively; p = 0.08), and this difference was statistically significant after adjusting for severity of illness, baseline nutritional status, and other factors (odds ratio, 2.4; 95% confidence interval [CI], 1.2 to 5.0; p = 0.009). The time to feeding and the caloric intake on day 4 of nutritional support were not different between the groups. The mean ( +/- SD) duration of mechanical ventilation was shorter in the postimplementation group (17.9 +/- 31.3 vs 11.2 +/- 19.5 days, respectively; p = 0.11), and this difference was statistically significant after adjusting for age, gender, severity of illness, type of admission, baseline nutritional status, and type of nutritional support (p = 0.03). There was no difference in ICU or hospital LOS between the two groups. The risk of death was 56% lower in patients who received enteral nutrition (hazard ratio, 0.44; 95% CI, 0.24 to 0.80; p =0.007).Conclusion: An evidence-based nutritional management protocol increased the likelihood that ICU patients would receive enteral nutritional, and the shortened their duration of mechanical ventilation. Enteral nutritional was associated with a reduced risk of death in those patients studied.