危重儿科患者的营养支持:当前的实践

IF 0.3 Q4 PEDIATRICS Journal of Pediatrics Review Pub Date : 2022-04-01 DOI:10.32598/jpr.10.2.919.3
F. Roudi, M. Sezavar, M. Naseri, Fahimeh Azadeh, G. Khademi
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引用次数: 0

摘要

背景:儿科重症监护室(PICU)收治的患者被认为是营养高危人群,对他们来说,最佳的能量和营养输送是预防器官功能障碍和随后不良临床结果的重要治疗策略。目的:本研究旨在调查危重儿童的营养充足指数及其与临床结果的可能关系。方法:该项目是在伊朗马什哈德阿克巴儿童医院进行的一项回顾性横断面研究。2019年5月至6月期间,所有PICU停留时间>48小时的危重症儿童均被纳入研究。提取患者的年龄、性别、医学诊断、营养状况、能量和蛋白质需求、分娩情况以及临床结果。结果:纳入71例患者,其中39例(54.9%)为男性。在有手术和非手术基础疾病的PICU患者中,营养不良的患病率分别为45.3%和52.4%。患者的营养状况(在PICU入院时间)、感染和死亡率之间存在显著相关性。估计能量需求和输送能量的平均±SEM值分别为85.7±1.6和68.3±2.1 kcal/kg/d。此外,估计的蛋白质需求量和蛋白质输送量分别为2.5±0.08和1.8±0.03 gr/kg/d。能量摄入与感染率呈负相关,较低的蛋白质输送与机械通气时间延长呈负相关。结论:能量/蛋白质输送与一些临床结果之间存在显著相关性。研究结果表明,有必要立即对不同营养干预措施的疗效进行进一步研究,并监测危重儿童的最佳营养支持障碍。
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Nutrition Support among Critically Ill Pediatric Patients: The Current Practice
Background: Pediatric Intensive Care Unit (PICU) admitted patients are considered as a nutritionally high-risk population, for whom optimum energy and nutrient delivery is an important treatment strategy preventing organ dysfunction and subsequently poor clinical outcomes. Objectives: The present study aimed to investigate the nutritional adequacy indices and their probable relations to clinical outcomes in critically ill children. Methods: This project was a retrospective cross-sectional study carried out at the Akbar Children’s Hospital, Mashhad, Iran. All critically ill children with PICU stay >48 hours during May-June 2019 were enrolled. Age, gender, medical diagnosis, nutritional status, energy and protein requirements and deliveries, and clinical outcomes of patients were extracted. Results: Seventy-one patients were included, among whom 39 subjects (54.9%) were male. The prevalence of malnutrition was 45.3% and 52.4% in PICU patients with surgical and non-surgical underlying diseases, respectively. There were significant associations between the nutritional status of the patients (upon the PICU admission time), infection, and mortality rate. Mean±SEM values of the estimated energy requirement and delivered energy were 85.7±1.6 and 68.3±2.1 kcal/kg/d, respectively. In addition, the estimated protein requirement and protein delivery were 2.5±0.08 and 1.8±0.03 gr/kg/d, respectively. Energy intake had a negative association with infection rate and lower protein delivery was negatively associated with prolonged duration of mechanical ventilation. Conclusions: Significant associations were found between energy/protein delivery and some clinical outcomes. The findings indicated the necessity of immediate further studies on the efficacy of different nutritional interventions as well as monitoring of optimal nutrition support barriers in critically ill children.
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