Safety of minimizing preoperative starvation in critically ill and intubated trauma patients.
Safety of minimizing preoperative starvation in critically ill and intubated trauma patients.
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DOI：
10.1097/ta.0000000000001011
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发表时间：
2016-06
期刊：
影响因子：
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通讯作者：
O'Keefe GE
中科院分区：
文献类型：
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作者：
Parent BA;Mandell SP;Maier RV;Minei J;Sperry J;Moore EE;O'Keefe GE
在手术/程序之前停止肠内营养是危重创伤患者喂养中断的最常见原因，并导致大量热量不足。本研究报告了一种通过持续喂养增加热量摄入的策略，直至转移至手术/程序。2006年修改了营养指南，允许插管患者继续进食，直到转移到手术室。在2006年之前，肠内喂养在手术前至少6小时停止。一项2003-2010年的回顾性队列设计比较了指南变更前后成人创伤受试者组的临床结局，以及未变更指南的其他中心受试者的临床结局。在第一周期间，实施前队列（n=245）中的受试者接受的中位数为3，787 kcal/人/周，而实施后队列（n=368）中的受试者接受的中位数为6，662（p<0.001）。其他研究中心的受试者（n=1002）的卡路里摄入量没有变化。与实施前队列相比，实施后急性呼吸窘迫综合征（ARDS）、肺炎和死亡率的风险降低（ARDS：RR=0.69，95% CI [0.59-0.81];肺炎：RR=0.82，95% CI [0.65-1.00];死亡率：RR=0.67，95% CI [0.46-0.99]）。无呼吸机天数增加1.4天（95% CI [0.1-2.7]），而ICU和住院时间不变。这些结果在其他参与中心显示出随时间推移的相似趋势。允许插管创伤患者继续肠内营养，直到转移到手术或程序与增加热量摄入有关，没有证据表明肺部并发症增加。这是减少创伤ICU热量不足的重要策略。III，研究类型：治疗/护理管理
Cessation of enteral nutrition prior to an operation/procedure is the most common reason for feeding interruption in critically-ill trauma patients and contributes to substantial calorie deficits. This study reports on a strategy to increase calorie intake by continuing feeds until transfer for operations/procedures. Nutrition guidelines were modified in 2006 to allow continuation of feeding in intubated patients up until transfer to the operating room. Prior to 2006, enteral feeding was stopped at least 6 hours prior to surgery. A retrospective cohort design from 2003–2010 compared clinical outcomes in groups of adult trauma subjects before and after guideline changes, and in subjects at other centers without guideline changes. During the first week, subjects in the pre-implementation cohort (n=245) received a median of 3,787 kcal/person/week, while subjects in the post-implementation cohort (n=368) received a median of 6,662 (p<0.001). There was no change in calorie intake for subjects at other centers (n=1002). The risks for Acute Respiratory Distress Syndrome (ARDS), pneumonia, and mortality were decreased after implementation relative to the pre-implementation cohort (ARDS: RR=0.69, 95% CI [0.59–0.81]; pneumonia: RR=0.82, 95% CI [0.65–1.00]; mortality: RR=0.67, 95% CI [0.46–0.99]). Ventilator-free days increased by 1.4 days (95% CI [0.1–2.7), while ICU and hospital length of stay were unchanged. These outcomes showed similar trends over time at other participating centers. Allowing intubated trauma patients to continue enteral nutrition until transfer for operations or procedures was associated with increased caloric intake without evidence of increased pulmonary complications. This represents an important strategy to reduce calorie deficits in the trauma ICU. III, Study Type: Therapeutic/Care Management