Global Study: Most ICU Patients Underfed

A large international multicentre cohort study shows that most of the patients are underfed during their ICU stay. In their findings published in the journal Clinical Nutrition, researchers say most of the patients in intensive care are receiving the same amount of calories regardless of their condition, patient's well-being is not satisfied, and delayed nutrition is more frequent. The findings show poor adherence to nutritional guidelines.

一项大规模国际多中心队列研究显示，多数患者在ICU住院期间喂养不足。该项研究发表在Clinical Nutrition杂志。研究者表示，无论病情如何，多数ICU患者接受了相同热卡摄入，患者情况并不令人满意，延迟进行营养支持极为普遍。这些发现表明营养指南的依从性很差。

From 2007 to 2013, a yearly one day cross sectional audit was performed to determine the nutrition practice in intensive care units and the associated outcome across the world. The data of this initiative called “nutritionDay ICU” were analysed by a team of researchers from Tel Aviv University (Israel) and Medical University Vienna (Austria).

从2007年至2013年，研究者在全球范围内每年进行为期一天的横断面调查，以了解ICU中营养支持治疗的现状。来自以色列特拉维夫大学以及奥地利维也纳医科大学的研究者们对这一称为“ICU营养日”的计划所得到的数据进行了分析。

For this study, a questionnaire translated in 17 languages was used to determine the unit's characteristics, patient's condition, nutrition condition and therapy as well as outcome. All the patients present in the morning of the one day prevalence study were included from 2007 to 2013.

在研究过程中，调查问卷被翻译成17种语言，用于了解ICU的特征，患者情况，营养状况和治疗以及预后。2007至2013年间，在研究当日的所有ICU患者均入选。

Overall, 9,777 patients from 46 countries and 880 units were covered by the survey. Their SAPS 2 was median 38 (IQR 27-51), predicted mortality was 30.7% ± 26.9, and their SOFA score 4.5 ± 3.4 with median 4 (IQR 2-7). Administration of calories did not appear to be related to actual or ideal body weight within all BMI groups. Patients with a BMI <18.5 or >40 received slightly less calories than all other BMI groups.

研究总共入选46个国家880个ICU的9777名患者。SAPS 2评分中位数为38 (IQR 27-51)，预期病死率为30.7% ± 26.9，SOFA 评分4.5 ± 3.4，中位数 4 (IQR 2-7)。在所有BMI组别那，患者摄入热卡与实际或理想体重无关。与其他患者相比，BMI < 18.5 或 > 40的患者摄入热卡稍少。

Two thirds of the patients were either ventilated or were in the ICU for longer than 24 hours at nutritionDay. Feeding was through the oral, enteral and parenteral routes. More than 40% of the patients were not fed during the first day. The mean energy administered using enteral route was 1,286 ± 663 kcal/day and using parenteral nutrition 1,440 ± 652 kcal/day. Sixty days mortality was 26.0%.

在研究当日，2/3的患者接受机械通气或在ICU超过24小时。患者经口、肠道及胃肠外途径接受喂养。超过40%的患者在第一天未接受喂养。经肠道给予的平均热卡为 1,286 ± 663 kcal/天，经胃肠外途径则为 1,440 ± 652 kcal/天。60天病死率为26.0%。

Based on the results, most of the ICU patients are fed enterally, that enteral feeding is started after a median of one day and that the nutritional target is rarely reached, if ever after five days. "Most surprisingly there appears to be no adaptation of energy intake to body weight as it is generally recommended. This observation is found overall and in the patients that were already a week or longer in the ICU," the research team notes.

基于上述结果，多数ICU患者接受肠道喂养，且开始肠道喂养的中位时间为1天，即便在5天后，患者也很少达到营养支持目标。研究者指出，“最令人惊奇的发现是，能量摄入并不像指南推荐那样，根据体重进行调整。在所有患者以及住ICU超过1周的患者均发现相同的结果”。

The study also suggests that recommendations and guidelines on proper nutrition for intensive care patients are failing to be implemented. "This may be explained by the fact that while early enteral nutrition is encouraged, intestinal failure as well as technical difficulties such as interruption for surgery or radiological procedures are frequently encountered, limiting the ability to achieve caloric goals," the team points out.

研究还提示，有关ICU患者适当营养的推荐意见和指南并未得到实施。研究团队指出：“可能的原因在于，尽管鼓励使用肠道营养，但胃肠功能衰竭以及技术上的困难（如因手术或影像学检查中断喂养）普遍存在，从而影响了热卡目标的实现。”

In addition, the researchers observed that there is a reluctance to use parenteral nutrition due to fear of infection complications risk. The study shows that only less than 15% of the studied population is receiving exclusive parenteral nutrition and less than 10% supplemental parenteral nutrition.

另外，研究者还观察到，出于对感染并发症风险的顾虑，人们并不情愿进行胃肠外营养。研究发现，仅有不足15%的患者接受完全的胃肠外营养，不足10%的患者接受额外的胃肠外营养。