【麻省总医院】外科重症监护病房患者肠内营养：低开慢走的代价

Nutr Clin Pract. 2016 Feb;31(1):86-90.

Nutrition in the Surgical Intensive Care Unit: The Cost of Starting Low and Ramping Up Rates.

Dijkink S, Fuentes E, Quraishi SA, Cropano C, Kaafarani HM, Lee J, King DR, DeMoya M, Fagenholz P, Butler K, Velmahos G, Yeh DD.

Massachusetts General Hospital, Boston, Massachusetts, USA.

BACKGROUND: Calorie/protein deficit in the surgical intensive care unit (SICU) is associated with worse clinical outcomes. It is customary to initiate enteral nutrition (EN) at a low rate and increase to goal (RAMP-UP). Increasing evidence suggests that RAMP-UP may contribute to iatrogenic malnutrition. We sought to determine what proportion of total SICU calorie/protein deficit is attributable to RAMP-UP.

MATERIALS AND METHODS: This is a retrospective study of a prospectively collected registry of adult patients (N = 109) receiving at least 72 hours of EN in the SICU according to the RAMP-UP protocol (July 2012-June 2014). Subjects receiving only trophic feeds or with interrupted EN during RAMP-UP were excluded. Deficits were defined as the amount of prescribed calories/protein minus the actual amount received. RAMP-UP deficit was defined as the deficit between EN initiation and arrival at goal rate. Data included demographics, nutritional prescription/delivery, and outcomes.

RESULTS: EN was started at a median of 34.0 hours (interquartile range [IQR], 16.5-53.5) after ICU admission, with a mean duration of 8.7 ± 4.3 days. The median total caloric deficit was 2185 kcal (249-4730), with 900 kcal (551-1562) attributable to RAMP-UP (41%). The protein deficit was 98.5 g (27.5-250.4), with 51.9 g (20.6-83.3) caused by RAMP-UP (53%).

CONCLUSIONS: In SICU patients initiating EN, the RAMP-UP period accounted for 41% and 53% of the overall caloric and protein deficits, respectively. Starting EN immediately at goal rate may eliminate a significant proportion of macronutrient deficit in the SICU.

KEYWORDS: caloric deficit; clinical protocols; critical illness; enteral nutrition; feeding protocols; intensive care units; nutritional support

PMID: 26673198

DOI: 10.1177/0884533615621047