Upper digestive intolerance during enteral nutrition in critically ill patients: Frequency, risk factors, and complications
Upper digestive intolerance during enteral nutrition in critically ill patients: Frequency, risk factors, and complications
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DOI：
10.1097/00003246-200110000-00018
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发表时间：
2001-10-01
影响因子：
8.8
通讯作者：
Bleichner, G
中科院分区：
文献类型：
--
作者：
Mentec, H;Dupont, H;Bleichner, G
Objective.目的探讨危重病人肠内营养（EN）期间胃排空量（GAV）增加、上消化道不耐受及其并发症的发生率和危险因素。前瞻性观察研究。综合医院重症监护室（ICU）。共153例患者采用鼻胃管喂养。干预措施：无。测量和主要结果：当连续两次测量GAV在150和500 mL之间时，当GAV> 500 mL时，或发生呕吐时，考虑上消化道不耐受。49例患者（32%; 95%置信区间[CI]，25%-42%）在中位EN持续时间2天（范围，1-16天）后出现GAV增加，70例患者（46%; 95% CI，38%-54%）出现上消化道不耐受。高GAV的独立危险因素是开始EN前GAV > 20 mL（比值比[OR]，2.16; 95% CI，1.11-4.18; p = 0.02），EN期间GAV > 100 mL（OR，1.49; 95% CI，1.01-2.19; p < .05），EN期间镇静（OR，1.78; 95% CI，1.17-2.71; p = .007），EN期间使用儿茶酚胺（OR，1.81; 95% CI，1.21-2.70; p = .004）。与高GAV相关的并发症是较低的摄食量（15 +/- 7 vs. 19 +/- 8 kcal/kg/d; p = .0004）和呕吐（53% vs. 23%; p = .0002）。与上消化道不耐受相关的并发症是肺炎的发展（43% vs. 24%; p = .01），ICU停留时间更长（23 +/- 21 vs. 15 +/- 16天; p = .007），ICU死亡率较高（41% vs. 25%; p = 0.03），即使调整简化急性生理评分11后（OR，1.48; 95%CI，1.04-2.10; p = 0.028）。在接受鼻胃管喂养的ICU患者中，高胃抽吸量是常见的，发生较早，并且在镇静或儿茶酚胺的患者中更常见。高胃吸出物量是上消化道不耐受的早期标志，与医院获得性肺炎的发生率较高、ICU住院时间较长和ICU死亡率较高相关。
Objective. To study the frequency of and risk factors for increased gastric aspirate volume (GAV) and upper digestive intolerance and their complications during enteral nutrition (EN) in critically ill patients.Design. Prospective observational study.Setting. Intensive care unit (ICU) in a general hospital.Patients. A total of 153 patients with nasogastric tube feeding.Interventions: None.Measurements and Main Results: Upper digestive intolerance was considered when GAV was between 150 and 500 mL at two consecutive measurements, when it was > 500 mL, or when vomiting occurred. Forty-nine patients (32%; 95% confidence interval [CI], 25%-42%) presented increased GAV after a median EN duration of 2 days (range, 1-16 days), and 70 patients (46%; 95% Cl, 38%-54%) presented upper digestive intolerance. Independent risk factors for high GAV were GAV > 20 mL before the start of EN (odds ratio [OR], 2.16; 95% Cl, 1.11-4.18; p = .02), GAV > 100 mL during EN (OR, 1.49; 95% Cl, 1.01-2.19; p < .05), sedation during EN (OR, 1.78; 95% Cl, 1.17-2.71; p = .007), use of catecholamines during EN (OR, 1.81; 95% Cl, 1.21-2.70; p = .004). Complications related to high GAV were a lower feed intake (15 +/- 7 vs. 19 +/- 8 kcal/kg/day; p = .0004) and vomiting (53% vs. 23%; p = .0002). Complications related to upper digestive intolerance were the development of pneumonia (43% vs. 24%; p = .01), a longer ICU stay (23 +/- 21 vs. 15 +/- 16 days; p = .007), and a higher ICU mortality (41% vs. 25%; p = .03), even after adjustment for Simplified Acute Physiology Score 11 (OR, 1.48; 95% Cl, 1.04-2.10; p = .028).Conclusion. In ICU patients receiving nasogastric tube feeding, high gastric aspirate volume was frequent, occurred early, and was more frequent in patients with sedation or catecholamines. High gastric aspirate volume was an early marker of upper digestive intolerance, which was associated with a higher incidence of nosocomial pneumonia, a longer ICU stay, and a higher ICU mortality.