Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients
Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients
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DOI：
10.1097/01.ta.0000249294.58703.11
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发表时间：
2007-07-01
影响因子：
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通讯作者：
Barquist, Erik S.
中科院分区：
文献类型：
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作者：
MacLeod, Jana B. A.;Lefton, Jennifer;Barquist, Erik S.
背景资料。这项研究比较了危重创伤患者的间歇喂养方案(每天需要的六分之一每4小时注入一次)和持续(滴注)喂养方案。有两个结果变量：达到目标量的时间和在重症监护病房住院的前10天100%通过肠道途径需要热量的天数。不良事件也被记录下来。一项前瞻性随机试验在一所大学I级创伤中心的创伤重症监护室进行。共有164名年龄在18岁及以上的创伤患者被送往创伤重症监护病房，没有胃肠道损伤，需要超过48小时的机械通气。患者随机接受肠内营养，通过间歇喂养方案而不是连续喂养方案。一位营养学家计算了卡路里和蛋白质的目标。严格记录每小时肠道摄入量、中断及其原因、腹泻和肺炎，以及标准的耐受性指南。结果：共有164名患者被随机分组，139名患者在7天内达到了计算的营养目标。两组管饲并发症发生率无统计学差异。间歇喂养的患者达到目标的速度更快，到第7天时达到目标的概率高于连续喂养的患者(X(2)=6.01，P=0.01)。间歇性患者在每名患者10天中有4天保持100%的目标(95%CI=3.5-4.4)，而滴注ARM仅在每名患者10天中有3天(95%CI=2.7-3.6)。间歇和连续喂养的患者在7天的研究期内都达到了目标，但间歇喂养的患者更早达到了目标肠道热量。间歇胃给药方案在逻辑上很简单，与标准的滴注给药方案有相同的效果。
Background. This study compared an intermittent feeding regimen (one-sixth of daily needs infused every 4 hours) with a continuous (drip) feeding regimen for critically ill trauma patients. There were two outcome variables: time to reach goal volume and the days on 100% of caloric needs via an enteral route in the first 10 days of the intensive care unit stay. Adverse events were also tallied.Methods. A prospective randomized trial was conducted in the trauma intensive care unit in a university Level I trauma center. A total of 164 trauma patients, 18 years of age and older were admitted to the trauma intensive care unit with a noninjured gastrointestinal tract and required more than 48 hours of mechanical ventilation. Patients were randornized to receive enteral nutrition via an intermittent feeding regimen versus a continuous feeding regimen. A single nutritionist calculated caloric and protein goals. A strict protocol was followed where hourly enteral intake, interruptions and their causes, diarrhea, and pneumonia were recorded, as well as standard guidelines for intolerance.Results: A total of 164 patients were randomized and 139 reached their calculated nutritional goal within 7 days. There were no statistical differences in complications of tube feeding. The patients intermittently fed reached the goal faster and by day 7 had a higher probability of being at goal than did the patients fed continuously (chi(2) = 6.01, p = 0.01). Intermittent patients maintained 100% of goal for 4 of 10 days per patient (95% CI = 3.5-4.4) as compared with the drip arm goal for only 3 of 10 days per patient (95% CI = 2.7-3.6).Conclusions. Patients from both the intermittent and continuous feeding regimens reached the goal during the study period of 7 days but the intermittent regimen patients reached goal enteral calories earlier. The intermittent gastric regimen is logistically simple and has equivalent outcomes to a standard drip-feeding regimen.