Before-after study of a standardized ICU protocol for early enteral feeding in patients turned in the prone position

被引:57
作者
Reignier, Jean [1 ,2 ,4 ]
Dimet, Jerome [2 ]
Martin-Lefevre, Laurent [1 ]
Bontemps, Frederic [1 ]
Fiancette, Maud [1 ]
Clementi, Eva [1 ]
Lebert, Christine [3 ]
Renard, Benoit [1 ]
机构
[1] Dist Hosp Ctr, Med Surg Intens Care Unit, La Roche Sur Yon, France
[2] Dist Hosp Ctr, Clin Res Unit, La Roche Sur Yon, France
[3] Hotel Dieu Univ Hosp, Emergency Unit, Nantes, France
[4] Univ Med, EA Clin & Expt Treatments Infect 3826, Nantes, France
关键词
Prone position; Nosocomial pneumonia; Enteral nutrition; Mechanical ventilation; Gastric emptying; Critically ill; MECHANICALLY VENTILATED PATIENTS; CRITICALLY-ILL PATIENTS; INTENSIVE-CARE-UNIT; NOSOCOMIAL PNEUMONIA; PARENTERAL-NUTRITION; CRITICAL ILLNESS; ADULT PATIENTS; BODY POSITION; INTOLERANCE; ERYTHROMYCIN;
D O I
10.1016/j.clnu.2009.08.004
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
Backgrounds & aims: To evaluate an intervention for improving the delivery of early enteral nutrition (EN) in patients receiving mechanical ventilation with prone positioning (PP). Methods: Eligible patients receiving EN and mechanical ventilation in PP were included within 48 h after intubation in a before-after study. Patients were semi-recumbent when supine. Intolerance to EN was defined as residual gastric volume greater than 250 ml/6 h or vomiting. In the before group (n = 34), the EN rate was increased by 500 ml every 24 h up to 2000 ml/24 h; patients were flat when prone and received erythromycin (250 mg IV/6 h) to treat intolerance. in the intervention group (n = 38), the EN rate was increased by 25 ml/h every 6 h to 85 ml/h, 25 degrees head elevation was used in PP, and prophylactic erythromycin was started at the first turn. Results: Compared to the before group, larger feeding volumes were delivered in the intervention group (median volume per day with PP, 774 ml [IQR 513-925] vs. 1170 ml [IQR 736-1417]; P < 0.001) without increases in residual gastric volume, vomiting, or ventilator-associated pneumonia. Conclusion: An intervention including PP with 25 degrees elevation, an increased acceleration to target rate of EN, and erythromycin improved EN delivery. (C) 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
引用
收藏
页码:210 / 216
页数:7
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