Nutrition Algorithms and Bedside Nutrient Delivery Practices in Pediatric Intensive Care Units An International Multicenter Cohort Study
Nutrition Algorithms and Bedside Nutrient Delivery Practices in Pediatric Intensive Care Units An International Multicenter Cohort Study
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DOI：
10.1177/0884533614530762
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发表时间：
2014-06-01
影响因子：
3.1
通讯作者：
Mehta, Nilesh M.
中科院分区：
文献类型：
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作者：
Martinez, Enid E.;Bechard, Lori J.;Mehta, Nilesh M.
背景：肠内营养（EN）递送与危重患者预后改善相关。我们的目的是描述儿科重症监护病房（picu）的EN实践，包括算法和个人床边实践的细节。方法：获取国际31个picu中可用的EN算法详细信息。前瞻性记录524例1个月至18岁机械通气患者的每日营养摄入数据，包括EN输送、辅助治疗和能量处方。通过回归分析确定与较高百分比的EN交付充分性相关的实践。结果：共有9种EN算法。所有算法都定义了超前和EN不容忍；9例中有7例根据胃残留量确定不耐受；9个中有3个推荐营养筛查和禁食指南。与美国肠外和肠内营养学会和欧洲儿科胃肠病学、肝病学和营养学会指南一致的内容很少。在341例仅接受EN治疗的患者中，32.9%的患者在第7天获得了规定能量的66.6%。输送EN的充分性百分比与EN开始的天数（-8.92,P < .001）和每次EN中断的小时数（-1.65,P = .001）呈负相关，与算法、促进剂或幽门后喂养的使用无关。结论：少数picu采用EN算法；建议是可变的，与国家指导方针不一致。在我们的队列中，只有不到三分之一的患者获得了最佳的EN递送。EN辅助治疗与EN输送增加无关。旨在促进早期EN和减少中断的研究可以优化PICU的能量输送。
Background: Enteral nutrition (EN) delivery is associated with improved outcomes in critically ill patients. We aimed to describe EN practices, including details of algorithms and individual bedside practices, in pediatric intensive care units (PICUs). Methods: Available EN algorithm details from 31 international PICUs were obtained. Daily nutrient intake data from 524 mechanically ventilated patients, 1 month to 18 years old, were prospectively documented, including EN delivery, adjunct therapies, and energy prescription. Practices associated with higher percentage adequacy of EN delivery were determined by regression analysis. Results: Nine EN algorithms were available. All algorithms defined advancement and EN intolerance; 7 of 9 defined intolerance by gastric residual volume; 3 of 9 recommended nutrition screening and fasting guidelines. Few elements were in agreement with the American Society for Parenteral and Enteral Nutrition and the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition guidelines. Of the 341 patients who received EN exclusively 32.9% received >= 66.6% of prescribed energy on day 7. Percentage adequacy of EN delivered was inversely associated with days to EN initiation (-8.92; P < .001) and hours per EN interruption (-1.65; P = .001) and was not associated with the use of algorithms, promotility agents, or postpyloric feeding. Conclusions: A minority of PICUs employ EN algorithms; recommendations were variable and not in agreement with national guidelines. Optimal EN delivery was achieved in less than one-third of our cohort. EN adjunct therapies were not associated with increased EN delivery. Studies aimed at promoting early EN and decreasing interruptions may optimize energy delivery in the PICU.