Enteral Nutrition Is a Risk Factor for Airway Complications in Subjects Undergoing Noninvasive Ventilation for Acute Respiratory Failure
Enteral Nutrition Is a Risk Factor for Airway Complications in Subjects Undergoing Noninvasive Ventilation for Acute Respiratory Failure
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DOI：
10.4187/respcare.05003
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发表时间：
2017-04-01
期刊：
影响因子：
2.5
通讯作者：
Tomii, Keisuke
中科院分区：
文献类型：
--
作者：
Kogo, Mariko;Nagata, Kazuma;Tomii, Keisuke
背景：一些研究和指南建议机械通气患者进行早期肠内营养。相反，早期肠内营养对无创通气（NIV）的影响尚未得到广泛研究。缺乏一个既定的气道保护方法表明，肠内营养管理这些患者可能会增加气道并发症和恶化的结果。方法：2007年1月至2015年1月，150例患者因急性呼吸衰竭入住我院呼吸科，接受NIV治疗>48小时。其中，107例不能口服摄入的受试者进行了回顾性分析。比较了接受和未接受肠内营养的受试者的临床背景和并发症。结果：107例接受NIV治疗的不能经口进食的受试者中有60例（56%）同时接受肠内营养。接受肠内营养的受试者血清白蛋白浓度显著低于未接受肠内营养的受试者（平均值2.7 +/- 0.68 mg/dL vs 3.0 0.75 mg/dL，P = 0.048）。与未接受肠内营养的受试者相比，接受肠内营养的受试者的气道并发症发生率显著更高（53% [32/60] vs 32% [15/47]，P = 0.03），中位NIV持续时间显著更长（16 [四分位距7-43] d vs 8 [5-20] d，P = 0.02）。多因素分析显示肠内营养与住院死亡率无关。结论：在接受NIV的受试者中，肠内营养与气道并发症风险增加相关，但不影响死亡率。肠内营养应仔细考虑这些患者。
BACKGROUND: Early enteral nutrition is recommended for mechanically ventilated patients in several studies and guidelines. In contrast, the effects of early enteral nutrition on noninvasive ventilation (NIV) have not been investigated extensively. The lack of an established method of airway protection suggests that enteral nutrition administration to these patients could increase airway complications and worsen outcomes. METHODS: Between January 2007 and January 2015, 150 patients were admitted to our respiratory department for acute respiratory failure and received NIV for >48 h. Of these, 107 subjects incapable of oral intake were retrospectively analyzed. Clinical background and complications were compared in subjects who did and did not receive enteral nutrition. RESULTS: Sixty of the 107 subjects (56%) incapable of oral intake who received NIV also received enteral nutrition. Serum albumin concentration was significantly lower in subjects who received enteral nutrition than in those who did not (mean 2.7 +/- 0.68 mg/dL vs 3.0 0.75 mg/dL, P =.048). The rate of airway complications was significantly higher (53% [32/60] vs 32% [15/47], P =.03), and median NIV duration was significantly longer (16 [interquartile range 7-43] d vs 8 [5-20] d, P =.02) in subjects who received enteral nutrition than in those who did not. Multivariate analysis showed that enteral nutrition was unrelated to in-hospital mortality. CONCLUSIONS: Among subjects receiving NIV, enteral nutrition was associated with increased risk of airway complications but did not affect mortality. Enteral nutrition should be carefully considered in these patients.