Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database.
Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database.
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DOI：
10.1186/cc13720
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发表时间：
2014-02-10
期刊：
影响因子：
--
通讯作者：
Heyland DK
中科院分区：
文献类型：
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作者：
Elke G;Wang M;Weiler N;Day AG;Heyland DK
目前的国际败血症指南建议在第一周进行低剂量的肠内营养(EN)。这与针对异种ICU患者组的其他营养指南相矛盾。目前尚缺乏脓毒症患者最佳EN剂量的数据。我们的目的是评估在一大群重症败血症患者中，EN给予的能量和蛋白质含量对临床结果的影响。我们对从国际营养研究中前瞻性收集的集合数据进行了二次分析。符合条件的患者被诊断为脓毒症和/或肺炎，并在≥住院3天，在入院后48小时内进行机械通气，仅接受EN。接受肠外营养的患者被排除在外。数据是从ICU入院到最多12天收集的。用回归模型检验卡路里和蛋白质摄入对60天死亡率和无呼吸机天数的影响。在数据集中的13,630名患者中，有2,270人符合研究纳入标准。仅通过EN，患者平均摄入1057千卡/天(14.5千卡/公斤/天)和49千克蛋白质/天(0.7千克/公斤/天)。患者接受机械通气的中位时间为8.4天，60天的死亡率为30.5%。增加1000千卡与减少60天死亡率(优势比(OR)0.61；95%可信区间(CI)0.48至0.77，P<；0.001)和更多无呼吸机天数(2.81天，95%CI 0.53至5.08，P = 0.02)以及每天增加30克蛋白质(OR 0.76；95%CI 0.65至0.87，P<；；0.001和1.92天，95%CI分别为0.58%和3.27%，P = 分别为0.005)。在重症脓毒症患者中，在ICU住院的早期阶段，EN提供的热量和蛋白质接近推荐量与更有利的结果相关。
Current international sepsis guidelines recommend low-dose enteral nutrition (EN) for the first week. This contradicts other nutrition guidelines for heterogenous groups of ICU patients. Data on the optimal dose of EN in septic patients are lacking. Our aim was to evaluate the effect of energy and protein amount given by EN on clinical outcomes in a large cohort of critically ill septic patients. We conducted a secondary analysis of pooled data collected prospectively from international nutrition studies. Eligible patients had a diagnosis of sepsis and/or pneumonia and were admitted to the ICU for ≥3 days, mechanically ventilated within 48 hours of ICU admission and only receiving EN. Patients receiving parenteral nutrition were excluded. Data were collected from ICU admission up to a maximum of 12 days. Regression models were used to examine the impact of calorie and protein intake on 60-day mortality and ventilator-free days. Of the 13,630 patients included in the dataset, 2,270 met the study inclusion criteria. Patients received a mean amount of 1,057 kcal/d (14.5 kcal/kg/day) and 49 g protein/day (0.7 g/kg/d) by EN alone. Patients were mechanically ventilated for a median of 8.4 days and 60-day mortality was 30.5%. An increase of 1,000 kcal was associated with reduced 60-day mortality (odds ratio (OR) 0.61; 95% confidence interval (CI) 0.48 to 0.77, P <0.001) and more ventilator-free days (2.81 days, 95% CI 0.53 to 5.08, P = 0.02) as was an increase of 30 g protein per day (OR 0.76; 95% CI 0.65 to 0.87, P <0.001 and 1.92 days, 95% CI 0.58 to 3.27, P = 0.005, respectively). In critically ill septic patients, a calorie and protein delivery closer to recommended amounts by EN in the early phase of ICU stay was associated with a more favorable outcome.