Tentative nil per os leads to poor outcomes in older adults with aspiration pneumonia
Tentative nil per os leads to poor outcomes in older adults with aspiration pneumonia
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DOI：
10.1016/j.clnu.2015.09.011
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发表时间：
2016-10-01
影响因子：
6.3
通讯作者：
Akagi, Junji
中科院分区：
文献类型：
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作者：
Maeda, Keisuke;Koga, Takayuki;Akagi, Junji
背景与目的：吸入性肺炎（AP）患者在治疗期间可能会出现吞咽功能下降，需要人工喂养方法。适当的 AP 治疗有助于维持日常生活活动。目的是评估暂定无口（NPO）状态对 AP 患者康复和吞咽能力下降的影响。 方法：在这项回顾性队列研究中，331 名在病前状态下经口食物摄入的 AP 患者因呕吐或呼吸功能不全等原因被排除后被纳入。根据入院时主治医生的指示，我们将受试者分为 2 组：早期口服（EOI）组和暂定 NPO 组。我们创建了一个与所有受试者分组相关的人口模型，这是一个同方差模型，通过治疗逆概率加权（IPTW）方法没有统计差异，并比较了组间结果。结果：在IPTW模型中，暂定的NPO状态导致自入院之日起1周内每天的营养摄入量较差（p <0.05），治疗持续时间显着更长（50％治疗长度：NPO组，13天[95％置信区间（CI）， 12.04-13.96] 和 EOI 组，8 天 [95% CI，7.69-8.31 [对数秩检验，p < 0.001]），并且治疗过程中吞咽能力下降更大（p < 0.001）。结论：入院时暂定的 NPO 状态与 AP 会给患者带来不良影响，包括治疗持续时间延长和吞咽能力下降。除了药物治疗之外，避免不必要的 NPO 可能是治疗 AP 并有助于患者预后的另一种方法。 (C) 2015 Elsevier Ltd 和欧洲临床营养与代谢学会。版权所有。
Background & aims: Patients with aspiration pneumonia (AP) may experience swallowing function declines during treatment, necessitating artificial feeding methods. Proper AP treatment contributes to maintaining activities of daily living. The aim was to assess the effect of tentative nil per os (NPO) status on the recovery of AP patients and declines in their swallowing abilities.Methods: In this retrospective cohort study, 331 patients with AP having oral food intake in premorbid status were included after exclusions for reasons such as vomiting or respiratory insufficiency. We divided subjects into 2 groups: an early oral intake (EOI) group and a tentative NPO group according to the directions by the attending doctors at admission. We created a population model related to groupings from all subjects, which was a homoscedastic model without statistical differences by the inverse probability of treatment weighted (IPTW) method and compared outcomes between the groups.Results: In the IPTW model, tentative NPO status resulted in poorer nutritional intake every day for 1 week from the date of admission (p < 0.05), a significantly longer treatment duration (50% treatment length: NPO group, 13 days [95% confidence interval (CI), 12.04-13.96] and EOI group, 8 days [95% CI, 7.69-8.31 [log rank test, p < 0.001]) and greater decline in swallowing ability over the course of treatment (p < 0.001).Conclusions: Tentative NPO status with AP at hospital admission resulted in adverse effects on patients, including prolonged treatment duration and declines in swallowing ability. Avoiding unnecessary NPO might be another method to treat AP and contribute to the patient's outcomes in addition to medication administration. (C) 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.