Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients
Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients
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DOI：
10.1378/chest.129.4.960
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发表时间：
2006-04-01
期刊：
影响因子：
9.6
通讯作者：
DiGiovine, B
中科院分区：
文献类型：
--
作者：
Artinian, V;Krayem, H;DiGiovine, B
研究目的：探讨早期肠内喂养对危重病人预后的影响。设计：对前瞻性收集的大型多机构ICU数据库进行回顾性分析。患者：共4,049例患者需要机械通气，持续bbbb2天。测量和结果：根据患者在机械通气开始后48小时内是否接受肠内喂养进行分类。2537名接受肠内喂养的患者（63%）被标记为“早期喂养组”，其余1512名患者（37%）被标记为“晚期喂养组”。早期喂养组ICU和住院总死亡率较低（分别为18.1%比21.4%,p = 0.01； 28.7%比33.5%,p = 0.001）。根据疾病严重程度评分的四分位数，早期喂养组的较低死亡率在病情最严重的组中最为明显。使用不同的评分分别建立了三个独立的模型（急性生理和慢性健康评估II、简化急性生理评分II和0时死亡率预测模型）。在所有模型中，早期肠内喂养与ICU死亡率降低约20%和住院死亡率降低25%相关。我们还分析了通过匹配倾向得分控制混杂后的数据。在这项分析中，早期喂养再次与降低ICU和住院死亡率相关。在所有调整分析中，发现早期喂养与呼吸机相关性肺炎（VAP）发生风险增加独立相关。结论：早期喂养显著降低ICU和医院死亡率，主要基于病情最严重患者的改善，尽管与VAP发生风险增加有关。建议接受机械通气的内科患者，特别是死亡风险高的患者，常规给予此类治疗。
Study objectives: To determine the impact of early enteral feeding on the outcome of critically ill medical patients.Design: Retrospective analysis of a prospectively collected large multi-institutional ICU database.Patients: A total of 4,049 patients requiring mechanical ventilation for > 2 days.Measurements and results: Patients were classified according to whether or not they received enteral feeding within 48 h of mechanical ventilation onset. The 2,537 patients (63%) who did receive enteral feeding were labeled as the "early feeding group," and the remaining 1,512 patients (37%) were labeled as the "late feeding group." The overall ICU and hospital mortality were lower in the early feeding group (18.1% vs 21.4%, p = 0.01; and 28.7% vs 33.5%, p = 0.001, respectively). The lower mortality rates in the early, feeding group were most evident in the sickest group as defined by quartiles of severity of illness scores. Three separate models were done using each of the different scores (acute physiology and chronic health evaluation II, simplified acute physiology score II, and mortality prediction model at time 0). In all models, early enteral feeding was associated with an approximately 20% decrease in ICU mortality and a 25% decrease in hospital mortality. We also analyzed the data after controlling for confounding by matching for propensity score. In this analysis, early feeding was again associated with decreased ICU and hospital mortality. In all adjusted analysis, early feeding was found to be independently associated with an increased risk of ventilator-associated pneumonia (VAP) developing.Conclusion: Early feeding significantly, reduces ICU and hospital mortality based mainly on improvements in the sickest patients, despite being associated with an increased risk of VAP developing. Routine administration of such therapy in medical patients receiving mechanical ventilation is suggested, especially in patients at high risk of death.