Comparison of different definitions of feeding intolerance: A retrospective observational study
Comparison of different definitions of feeding intolerance: A retrospective observational study
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DOI：
10.1016/j.clnu.2014.10.006
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发表时间：
2015-10-01
影响因子：
6.3
通讯作者：
Starkopf, Joel
中科院分区：
文献类型：
--
作者：
Blaser, Annika Reintam;Starkopf, Liis;Starkopf, Joel
背景与目的：虽然喂养不耐受（FI）在危重症患者中具有重要的临床意义，但其定义并不一致。通过根据胃肠道功能障碍的症状和体征与死亡率之间的关系来评估FI的定义，目的是使用与随后死亡率最密切相关的定义来定义FI。方法：对2004年至2011年间入住单一ICU并接受肠内营养（EN）的所有成年患者的数据进行分析。每天记录EN的给药量、肠音缺失（BS）、呕吐和/或反流、腹泻、肠胀和胃残量大（GRVs）。GRV >= 500 ml/天被认为是大的，每天计算胃肠道（GI）症状的总和，包括大GRV。对FI的各种定义进行了建模。评估仅使用GRV的定义，或GRV伴其他胃肠道症状的定义，或GRV未达到预设EN目标的定义。通过将FI的存在（逐一检验不同的定义）与入院日人口统计学和疾病严重程度变量一起加入多元回归分析，来检验FI对死亡率的预测能力。结果：纳入的1712例患者中，221例（12.9%）在ICU死亡，495例（28.9%）在入院后90天内死亡。以出现至少五分之三的胃肠道症状为基础的FI定义与icu死亡率密切相关（幸存者患病率为6.3%，非幸存者患病率为23.5%,p < 0.001，优势比（95%CI） 3.39(2.23-5.14)），而EN
Background & aims: While feeding intolerance (FI) is clinically important in the critically ill it is inconsistently defined. By evaluating definitions of FI based on relationships between symptoms and signs of gastrointestinal (GI) dysfunction and mortality the objective was to define FI using the definition that was most strongly associated with subsequent mortality.Methods: Data from all adult patients admitted to a single ICU between 2004 and 2011, and who were receiving enteral nutrition (EN), were analysed. The amount of EN administered, presence of absent bowel sounds (BS), vomiting and/or regurgitation, diarrhoea, bowel distension, and large gastric residual volumes (GRVs) were documented daily. A GRV >= 500 ml/day was considered as large and the sum of gastrointestinal (GI) symptoms including large GRV was calculated daily. Various definitions of FI were modelled. Definitions using only GRV, or GRV with other GI symptoms, or GRV and failure to reach preset EN targets were evaluated. The predictive power of FI on mortality was tested by adding the presence of FI (different definitions were tested one-by-one) into multiple regression analyses together with admission day demographic and severity of illness variables.Results: Of the 1712 patients included, 221 (12.9%) died in ICU and 495 (28.9%) had died within 90 days after ICU admission. The definition of FI based on the presence of at least three out of five GI symptoms was most strongly related to ICU-mortality (6.3% prevalence in survivors vs. 23.5% in non-survivors, p < 0.001, odds ratio (95%CI) 3.39 (2.23-5.14)), whereas EN