Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure.
Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure.
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DOI：
10.1097/ccm.0b013e31820a905a
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发表时间：
2011-05
影响因子：
8.8
通讯作者：
Wheeler AP
中科院分区：
文献类型：
--
作者：
Rice TW;Mogan S;Hays MA;Bernard GR;Jensen GL;Wheeler AP
肠内营养提供给不能正常进食的机械通气患者，但所需的支持量尚不清楚。我们进行了这项随机、开放标签研究，以检验以下假设：在急性呼吸衰竭患者中，与初始全能量肠内营养相比，初始低容量（即营养型）肠内营养可减少胃肠道不耐受/并发症的发生，并改善结局。随机、开放标签研究200例预计需要机械通气至少72小时的急性呼吸衰竭患者。患者在通气的最初6天随机接受初始营养（10 ml/hr）或全能量肠内营养。主要结局指标为至第28天的无呼吸机天数。98例随机分配至营养组的患者和102例随机分配至全能量营养组的患者的基线特征相似。入组时，患者的平均APACHE II评分为26.9，PaO 2/FiO 2为182，38%处于休克状态。两组接受相似的肠内营养持续时间（5.5 vs. 5.1天; P=0.51）。营养组在第6天每天平均摄入目标热量的15 ± 11%，而全能量组为74.8 ± 38.5%（P<0.001）。两组的中位无呼吸机天数为23.0天（P=0.90），无ICU天数为21.0天（P=0.64）。营养组出院死亡率为22.4%，而全能量组为19.6%（P=0.62）。在前6天，营养组的腹泻趋势更少（19%对24%的喂养日; P=0.08），胃残留量升高的事件明显更少（2%对8%的喂养日; P<0.001）。在急性呼吸衰竭机械通气患者中，初始营养性肠内营养与早期全能量肠内营养的临床结局相似，但胃肠道不耐受的发生率更低。
Enteral nutrition is provided to mechanically ventilated patients who cannot eat normally, yet the amount of support needed is unknown. We conducted this randomized, open-label study to test the hypothesis that initial low-volume (i.e. trophic) enteral nutrition would decrease episodes of gastrointestinal intolerance/complications and improve outcomes as compared to initial full-energy enteral nutrition in patients with acute respiratory failure. Randomized, open-label study 200 Patients with acute respiratory failure expected to require mechanical ventilation for at least 72 hours Patients were randomized to receive either initial trophic (10 ml/hr) or full-energy enteral nutrition for the initial 6 days of ventilation. The primary outcome measure was ventilator-free days to day 28. Baseline characteristics were similar between the 98 patients randomized to trophic and the 102 patients randomized to full-energy nutrition. At enrollment, patients had a mean APACHE II score of 26.9, PaO2/FiO2 of 182 and 38% were in shock. Both groups received similar duration of enteral nutrition (5.5 vs. 5.1 days; P=0.51). The trophic group received an average of 15 ± 11% of goal calories daily through day 6 compared to 74.8 ± 38.5% (P<0.001) for the full-energy group. Both groups had a median of 23.0 ventilator-free (P=0.90) and 21.0 ICU-free days (P=0.64). Mortality to hospital discharge was 22.4% for trophic vs. 19.6% for full-energy (P=0.62). In the first 6 days, the trophic group had trends for less diarrhea (19 vs. 24% of feeding days; P=0.08) and significantly fewer episodes of elevated gastric residual volumes (2 vs. 8% of feeding days; P<0.001). Initial trophic enteral nutrition resulted in similar clinical outcomes in mechanically ventilated patients with acute respiratory failure as early full-energy enteral nutrition but with fewer episodes of gastrointestinal intolerance.