NutritionDay ICU: A 7 year worldwide prevalence study of nutrition practice in intensive care
NutritionDay ICU: A 7 year worldwide prevalence study of nutrition practice in intensive care
复制标题
DOI：
10.1016/j.clnu.2016.07.012
复制
发表时间：
2017-08-01
影响因子：
6.3
通讯作者：
Hiesmayr, Michael
中科院分区：
文献类型：
--
作者：
Bendavid, Itai;Singer, Pierre;Hiesmayr, Michael
简介：为了确定世界各地重症监护病房的营养实践和相关结果，从2007年到2013年进行了每年1天的横断面审计。这项名为“营养日ICU”的倡议的数据进行了分析。材料和方法：采用17种语言翻译的调查问卷，确定该单位的特点、患者的情况、营养状况和治疗方法以及结果。纳入2007 - 2013年1天患病率研究中上午出现的所有患者。结果：纳入46个国家、880个单位的9777例患者。SAPS 2中位数为38 (IQR 27-51)，预测死亡率为30.7% +/- 26.9，SOFA评分为4.5 +/- 3.4，中位数为4 （IQR 2-7）。在所有BMI组中，卡路里的摄入似乎与实际或理想体重无关。BMI为40的患者比其他所有BMI组的患者摄入的卡路里略少。三分之二的患者在营养日时进行了通气或在ICU的时间超过24小时。喂养方式有口服、肠内和肠外三种。超过40%的患者在第一天没有进食。肠内营养的平均能量为1286 +/- 663 kcal/天，肠外营养的平均能量为1440 +/- 652 kcal/天。60天死亡率为26.0%。讨论：这个非常大的合作队列研究表明，根据实际建议，大多数患者在ICU住院期间营养不良。处方卡路里似乎与病人的理想体重无关。营养支持起步缓慢，从未达到建议的目标。在ICU住院期间，肠外营养处方正在增加，但如果ICU住院时间为一周或更长，则仅占研究人群的20%。世界范围内的营养支持似乎不以体重或疾病为指导，而更多的是标准化和限制在一定的卡路里水平。这些观察结果显示了对指导方针的不良遵守。(C) 2016爱思唯尔有限公司和欧洲临床营养与代谢学会。版权所有。
Introduction: To determine the nutrition practice in intensive care units and the associated outcome across the world, a yearly 1 day cross sectional audit was performed from 2007 to 2013. The data of this initiative called "nutritionDay ICU" were analyzed.Material and methods: A questionnaire translated in 17 languages was used to determine the unit's characteristics, patient's condition, nutrition condition and therapy as well as outcome. All the patients present in the morning of the 1 day prevalence study were included from 2007 to 2013.Results: 9777 patients from 46 countries and 880 units were included. Their SAPS 2 was median 38 (IQR 27-51), predicted mortality was 30.7% +/- 26.9, and their SOFA score 4.5 +/- 3.4 with median 4 (IQR 2-7). Administration of calories did not appear to be related to actual or ideal body weight within all BMI groups. Patients with a BMI 40 received slightly less calories than all other BMI groups. Two third of the patients were either ventilated or were in the ICU for longer than 24 h at nutritionDay. Routes of feeding used were the oral, enteral and parenteral routes. More than 40% of the patients were not fed during the first day. The mean energy administered using enteral route was 1286 +/- 663 kcal/day and using parenteral nutrition 1440 +/- 652 kcal/day. 60 days mortality was 26.0%.Discussion: This very large collaborative cohort study shows that most of the patients are underfed during according to actual recommendations their ICU stay. Prescribed calories appear to be ordered regardless to the ideal weight of the patient. Nutritional support is slow to start and never reaches the recommended targets. Parenteral nutrition prescription is increasing during the ICU stay but reaching only 20% of the population studied if ICU stay is one week or longer. The nutritional support worldwide does not seem to be guided by weight or disease but more to be standardized and limited to a certain level of calories. These observations are showing the poor observance to guidelines. (C) 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.