Effect of Added Free Water to Enteral Tube Feeds in Children Receiving Commercial Blends.
Effect of Added Free Water to Enteral Tube Feeds in Children Receiving Commercial Blends.
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DOI：
10.1097/mpg.0000000000003308
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发表时间：
2022-03-01
影响因子：
2.9
通讯作者：
Rosen, Rachel
中科院分区：
文献类型：
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作者：
Hirsch, Suzanna;Solari, Toni;Rosen, Rachel
为了确定自由水给药对病情复杂的患者临床结果的影响，基于以下假设：接受更多稀液体的患者结果较差，与胃食管反流风险增加相关。这是对 2010 年至 2019 年开始接受商业混合管喂养的儿童进行的回顾性图表审查。根据国际吞咽困难饮食标准化倡议 (IDDSI) 框架，确定了胃造口摄入稀液体的百分比，稀液体包括游离水或稀配方奶粉。患者被分为接受少量稀液体的患者（“稀薄百分比”<20%）和接受大量稀薄液体的患者（“稀薄百分比”>20%）。比较了开始混合后一年内的急诊室就诊、住院和胸部 X 光检查。包括 45 名年龄在 12 个月至 18.7 岁（中位年龄 3.7 岁）的患者。 20 名患者 (44%) 正在接受 IDDSI 分类的稀薄混合物，25 名患者 (56%) 正在接受较稠的混合物。除混合物外，患者每天平均饮用 320 毫升的水（范围 0-1000 毫升）。接受 < 20% 稀薄液体的患者在随访期间接受胸部 X 光检查的可能性低于接受大量稀薄液体的患者（最小稀薄液体组为 10%，较大稀薄液体组为 48%，P = 0.03）。在多变量逻辑回归中，在控制了潜在的肺部疾病、误吸、饲喂方法（推注或连续饲喂）、胃底折叠术状态和口服摄入状态后，这种关系仍然显着。我们的研究表明，接受混合管喂养的患者所接受的添加稀液体（例如水）的量差异很大。在管饲中添加水虽然通常是为了水合作用，但可以改变饲料粘度和临床结果，例如胸部 X 光表现。
To determine the impact of free water administration on clinical outcomes in medically complex patients, based on the hypothesis that patients receiving more thin liquids have worse outcomes related to increased risk of gastroesophageal reflux. This was a retrospective chart review of children initiated on commercial blenderized tube feedings from 2010 to 2019. The percentage of gastrostomy intake that was a thin liquid was determined, with thin liquids including free water or thin formula based on the International Dysphagia Diet Stardardization Initiative (IDDSI) framework. Patients were categorized into those receiving low volumes of thin liquids (“percent thin” < 20%) and those receiving higher volumes (“percent thin” > 20%). Emergency room visits, hospital admissions, and chest x-rays during the year after starting the blend were compared. Forty-five patients age 12 months to 18.7 years (median 3.7 years) were included. Twenty patients (44%) were receiving a blend with an IDDSI-categorized thin consistency and 25 patients (56%) were receiving a thicker blend. In addition to the blend, patients received a median of 320mL per day of water (range 0–1000mL). Patients receiving < 20% thin liquids were less likely to undergo chest x-rays during follow-up than patients receiving larger amounts of thin liquids (10% in the minimal thin group vs. 48% in the greater thin group, P = 0.03). In a multivariable logistic regression, this relationship remained significant after controlling for underlying pulmonary disease, aspiration, method of feed administration (bolus or continuous feeds), fundoplication status, and oral intake status. Our study demonstrates that patients on blenderized tube feeds receive widely variable amounts of added thin liquids, like water. The addition of water to tube feeds, while typically given for hydration, can modify feed viscosity and clinical outcomes, such as chest x-ray performance.