接受血管活性药物的重症患儿进行肠内喂养的安全性
堪萨斯大学医学中心
威斯康星医学院
威斯康星州儿童医院
背景：该回顾性研究旨在评估对接受血管活性药物（VA）的患儿进行肠内喂养的安全性。
方法：本研究纳入了在2007年～2008年在小儿重症监护病房入住≥96h同时使用VA（肾上腺素、去甲肾上腺素、血管加压素、米力农、多巴胺、多巴酚丁胺）的1月～18岁患儿，并将其分为喂养组和非喂养组。观察两组的人口统计学资料、临床特征、VA的种类和剂量以及胃肠道（GI）结局。通过χ²检验、Mann-Whitney检验以及逻辑回归对两组的GI结局进行分析。
结果：共纳入了339名患儿，其中55%被分到了喂养组，45%被分到非喂养组。与非喂养组相比，喂养组的年龄更小（平均年龄：1.05岁比2.75岁，P＜0.001），死亡指数2（PIM2）死亡风险（ROM）更低（中位数：3.33%比3.52%；P=.106）。与非喂养组相比，喂养组的死亡率更低（6.9%比15.9%；比值比[OR]：0.39；95% CI：0.18～0.84；P＜0.01，）。而两组的GI结局无差别。两组的血管活性-变应性评分（VIS）无不同，除了第1天（P=0.017）。在第1天对年龄、PIM2ROM、VIS进行匹配后，两组ROM无差异（OR：0.58；95% CI：0.26～1.28；P=0.18）。
结论：在接受VA的患儿中进行肠内喂养对GI结局无影响，而死亡率有所降低。然而还需要进一步前瞻性研究证实在接受VA患儿中进行肠内喂养的安全性。
JPEN J Parenter Enteral Nutr. 2016;40(2):236-41.
Safety of Enteral Feedings in Critically Ill Children Receiving Vasoactive Agents.
Panchal AK, Manzi J, Connolly S, Christensen M, Wakeham M, Goday PS, Mikhailov TA.
University of Kansas Medical Center, Kansas City, Kansas; Pediatric Critical Care, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin.
BACKGROUND: The objective of this retrospective study was to evaluate the safety of enteral feeding in children receiving vasoactive agents (VAs).
METHODS: Patients aged 1 month to 18 years with a pediatric intensive care unit stay for ≥96 hours during 2007 and 2008 who received any VA (epinephrine, norepinephrine, vasopressin, milrinone, dopamine, and dobutamine) were included and categorized into fed and nonfed groups. Their demographics, clinical characteristics, type and dose of VA, and presence of gastrointestinal (GI) outcomes were obtained. GI outcomes were compared between the groups by the χ(2) test, Mann-Whitney test, and logistic regression.
RESULTS: In total, 339 patients were included. Of these, 55% were in the fed group and 45% in the nonfed group. Patients in the fed group were younger (median age, 1.05 vs 2.75 years, respectively; P < .001) and tended to have a lower Pediatric Index of Mortality 2 (PIM2) risk of mortality (ROM) than those in the nonfed group (median, 3.33% vs 3.52%, respectively; P = .106). Mortality was lower in the fed group than the nonfed group (6.9% vs 15.9%, respectively; odds ratio [OR], 0.39; 0.18-0.84; P < .01, 95% CI), while GI outcomes did not differ between the groups. The vasoactive-inotropic score (VIS) did not differ between the groups except on day 1 (P = .017). The ROM did not differ between the groups after adjusting for age, PIM2 ROM, and VIS on day 1 (OR, 0.58; 0.26-1.28; P = .18, 95% CI).
CONCLUSIONS: Enteral feeding in patients receiving VAs is associated with no difference in GI outcomes and a tendency towards lower mortality. Prospective studies are required to confirm the safety of enteral feedings in patients receiving VAs.
KEYWORDS: adverse gastrointestinal outcomes; critically ill children; enteral feeding; mortality; vasoactive agents
PMID: 25168592
DOI: 10.1177/0148607114546533
