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[NEJM在线发表]:危重病患者高热卡与常规肠内营养支持
2018年10月31日 时讯速递, 进展交流 暂无评论

ORIGINAL ARTICLE

Energy-Dense versus Routine Enteral Nutrition in the Critically Ill

The TARGET Investigators, for the ANZICS Clinical Trials Group

N Engl J Med October 22, 2018

DOI: 10.1056/NEJMoa1811687

Abstract

BACKGROUND 背景

The effect of delivering nutrition at different calorie levels during critical illness is uncertain, and patients typically receive less than the recommended amount.

危重病阶段给予不同热卡水平营养的效果尚不明确,患者接受的热卡通常低于推荐目标。

METHODS 方法

We conducted a multicenter, double-blind, randomized trial, involving adults undergoing mechanical ventilation in 46 Australian and New Zealand intensive care units (ICUs), to evaluate energy-dense (1.5 kcal per milliliter) as compared with routine (1.0 kcal per milliliter) enteral nutrition at a dose of 1 ml per kilogram of ideal body weight per hour, commencing at or within 12 hours of the initiation of nutrition support and continuing for up to 28 days while the patient was in the ICU. The primary outcome was all-cause mortality within 90 days.

我们在澳大利亚和新西兰46个ICU进行了一项多中心、双盲、随机临床试验,纳入接受机械通气的成年患者,对高能量(1.5 kcal/ml)与常规(1.0 kcal/ml)肠内营养进行比较。肠内营养输注速度1 ml/kg理想体重/h,启动营养支持时或12小时内达到热卡目标,直至第28天(若患者仍在ICU住院)。主要预后指标为90天全因病死率。

RESULTS 结果

There were 3957 patients included in the modified intention-to-treat analysis (1971 in the 1.5-kcal group and 1986 in the 1.0-kcal group). The volume of enteral nutrition delivered during the trial was similar in the two groups; however, patients in the 1.5-kcal group received a mean (±SD) of 1863±478 kcal per day as compared with 1262±313 kcal per day in the 1.0-kcal group (mean difference, 601 kcal per day; 95% confidence interval [CI], 576 to 626). By day 90, a total of 523 of 1948 patients (26.8%) in the 1.5-kcal group and 505 of 1966 patients (25.7%) in the 1.0-kcal group had died (relative risk, 1.05; 95% CI, 0.94 to 1.16; P=0.41). The results were similar in seven predefined subgroups. Higher calorie delivery did not affect survival time, receipt of organ support, number of days alive and out of the ICU and hospital or free of organ support, or the incidence of infective complications or adverse events.

共有3957名患者纳入修订意向治疗分析(1.5-kcal组1971名患者,1.0-kcal组1986名患者)。试验期间两组患者接受的肠内营养容量相似;然而,1.5-kcal组患者平均每日热卡摄入 (±SD) 1863±478 kcal,而1.0-kcal组患者为 1262±313 kcal(平均差异 601 kcal/d;95% 可信区间 [CI], 576 to 626)。至第90天时,1.5-kcal组1948名患者中523名(26.8%),以及1.0-kcal组1966名患者中505名(25.7%)患者死亡(相对危险度,1.05;95% CI, 0.94 to 1.16;P=0.41)。预先确定的7个亚组分析结果相似。给予高热卡不影响存活时间、器官功能支持治疗、非ICU或住院存活天数、无器官支持天数,或感染性并发症及不良事件发生率。

CONCLUSIONS 结论

In patients undergoing mechanical ventilation, the rate of survival at 90 days associated with the use of an energy-dense formulation for enteral delivery of nutrition was not higher than that with routine enteral nutrition.

对于接受机械通气的患者,与常规肠内营养相比,采用高能量配方进行肠内营养不改善90天存活率。

(Funded by National Health and Medical Research Institute of Australia and the Health Research Council of New Zealand; TARGET ClinicalTrials.gov number, NCT02306746.)

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