俯卧位机械通气患者的肠内营养

　　背景：俯卧位接受机械通气患者发生喂养不耐受风险有所增加。然而，支持该结论的文献有限而且互相矛盾。

　　目的：对接受俯卧位机械通气患者进行肠内营养（EN）可行性和疗效以及相关并发症研究。

　　方法：该前瞻性3年观察性研究纳入了34例机械通气俯卧位重症监护病房患者。对EN疗效和安全性相关终点进行了研究。

　　结果：3年期间总共有超过1200例入住重症监护病房患者。其中，34例俯卧位接受机械通气。EN平均天数为24.7±12.3。仰卧位进行EN平均天数显著长于俯卧位（21.1比3.6；P＜0.001），但是每天EN后胃内残留量（126.6比189.2；P=0.054）及进食容积比（94.1%比92.8%；P=0.21）差异无统计学意义。胃内残留量过多次数（0.06比0.09；P=0.39）、呕吐次数（0.016比0.03；P=0.53）、反胃次数（0比0.04；P=0.051）均无显著差异。

　　结论：对伴有严重血氧不足需要俯卧位机械通气重症患者进行肠内营养可行、安全，而且并不会增加胃肠道并发症。需要更大规模研究证实以上发现。

JPEN J Parenter Enteral Nutr. 2016;40(2):250-5.

Enteral Nutrition in Patients Receiving Mechanical Ventilation in a Prone Position.

Saez de la Fuente I, Saez de la Fuente J, Quintana Estelles MD, Garcia Gigorro R, Terceros Almanza LJ, Sanchez Izquierdo JA, Montejo Gonzalez JC.

Department of Intensive Care Medicine, Hospital Universitario, Madrid, Spain; Department of Pharmacy, Hospital Universitario Infanta Leonor, Madrid, Spain.

BACKGROUND: Patients treated with mechanical ventilation in the prone position (PP) could have an increased risk for feeding intolerance. However, the available evidence supporting this hypothesis is limited and contradictory.

OBJECTIVE: To examine the feasibility and efficacy of enteral nutrition (EN) support and its associated complications in patients receiving mechanical ventilation in PP.

METHODS: Prospective observational study including 34 mechanically ventilated intensive care patients who were turned to the prone position over a 3-year period. End points related to efficacy and safety of EN support were studied.

RESULTS: In total, more than 1200 patients were admitted to the intensive care unit over a period of 3 years. Of these, 34 received mechanical ventilation in PP. The mean days under EN were 24.7 ± 12.3. Mean days under EN in the supine position were significantly higher than in PP (21.1 vs 3.6; P < .001), but there were no significant differences in gastric residual volume adjusted per day of EN (126.6 vs 189.2; P = .054) as well as diet volume ratio (94.1% vs 92.8%; P = .21). No significant differences in high gastric residual events per day of EN (0.06 vs 0.09; P = .39), vomiting per day of EN (0.016 vs 0.03; P = .53), or diet regurgitation per day of EN (0 vs 0.04; P = .051) were found.

CONCLUSIONS: EN in critically ill patients with severe hypoxemia receiving mechanical ventilation in PP is feasible, safe, and not associated with an increased risk of gastrointestinal complications. Larger studies are needed to confirm these findings.

KEYWORDS: critical care; enteral nutrition; hypoxemia; mechanical ventilation; prone position; respiratory failure

PMID: 25274497

DOI: 10.1177/0148607114553232