Experience with an enteral-based nutritional support regimen in critically ill trauma patients.
Experience with an enteral-based nutritional support regimen in critically ill trauma patients.
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DOI：
10.1016/j.jamcollsurg.2013.08.006
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发表时间：
2013-12
影响因子：
5.2
通讯作者：
O'Keefe, Grant E.
中科院分区：
文献类型：
--
作者：
Chung, Christina K.;Whitney, Ryan;Thompson, Callie M.;Pham, Tam N.;Maier, Ronald V.;O'Keefe, Grant E.
确保危重病人有足够的肠内营养支持是具有挑战性的。通过描述我们的经验，我们试图描述强调肠内营养(EN)的方法的挑战、好处和并发症。我们检查了来自八个创伤中心的钝性创伤受害者接受的营养支持。我们根据前7周的平均每日肠道卡路里摄入量对受试者进行分组。第一组在第一周摄入的卡路里最少(0千卡/公斤/天)，而第五组的热量最多(16-30千卡/公斤/天)。我们重点分析了在重症监护病房住≥8天的患者，并比较了不同组的临床结果。1100名受试者在重症监护室接受≥治疗8天。在第一周接受最多肠道热量摄入的患者(第5组)的VAP发生率最高(49%)，菌血症发生率最低(14%)。肠外营养的使用与菌血症(AOR=2.5，95%CI=1.8~3.5)、VAP(AOR=2.4，95%CI=1.7~3.3)和死亡率(AOR=1.9，95%CI=1.1~3.1)有关。我们的观察结果支持在损伤后的第一周内控制肠道摄入，避免肠外营养。
Assuring adequate enteral nutritional support in critically ill patients is challenging. By describing our experience we sought to characterize the challenges, benefits and complications of an approach that stresses enteral nutrition (EN). We examined nutritional support received by victims of blunt trauma from eight trauma centers. We grouped subjects according to the average daily enteral caloric intake over the first 7. Group 1 received the fewest (0 kcal/kg/day) and group 5 the greatest (16 – 30 kcal/kg/day) number of calories in the first week. We focused our analyses on the patients remaining in the ICU for ≥ 8 days and compared clinical outcomes among the groups. 1100 subjects were in the ICU for ≥8 days. Patients receiving the greatest number of enteral calories during the first week (group 5) had the highest incidence of VAP (49%) and the lowest incidence of bacteremia (14%). The use of parenteral nutrition was associated with bacteremia (aOR = 2.5, 95% CI = 1.8 – 3.5), VAP (aOR = 2.4, 95% CI = 1.7 – 3.3) and death (aOR = 1.9, 95% CI = 1.1 – 3.1) Enteral caloric intake during the first week was related to the pattern and severity of injury and associated with important infectious outcomes. Our observations support moderating enteral intake during the first week after injury and avoiding parenteral nutrition.
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DOI：
10.1097/01.ta.0000225933.08478.65
发表时间：
2006-07-01
影响因子：
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作者：
Moore, Frederick A.;McKinley, Bruce A.;Maier, Ronald V.
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2006-05-01
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Maier, Ronald V.
影响因子：
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作者：
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通讯作者：
MOORE, EE
DOI：
10.1097/ta.0b013e3181826df7
发表时间：
2008-10-01
影响因子：
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作者：
Cuschieri, Joseph;Freeman, Brad;Maier, Ronald V.
通讯作者：
Maier, Ronald V.