Time to achieve delivery of nutrition targets is associated with clinical outcomes in critically ill children

被引:24
|
作者
Bechard, Lori J.
Staffa, Steven J.
Zurakowski, David
Mehta, Nilesh M. [1 ]
机构
[1] Boston Childrens Hosp, Dept Anesthesiol Crit Care & Pain Med, Boston, MA 02115 USA
来源
AMERICAN JOURNAL OF CLINICAL NUTRITION | 2021年 / 114卷 / 05期
关键词
pediatrics; nutritional support; critical care; pediatric intensive care unit; enteral nutrition; parenteral nutrition; energy adequacy; protein adequacy; early nutrition; LATE PARENTERAL-NUTRITION; MORTALITY; MULTICENTER; PROVISION;
D O I
10.1093/ajcn/nqab244
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
Background: Optimal nutrition in critically ill children involves a complex interplay between the doses, route, and timing of macronutrient delivery. Objectives: We aimed to examine the association between the time to achieve delivery of 60% of the prescribed energy and protein targets and clinical outcomes in mechanically ventilated children. Methods: We conducted a prospective, observational cohort study of mechanically ventilated children admitted to pediatric intensive care units (PICUs) worldwide. Daily energy and protein delivery were recorded for up to 10 d in the PICU. We calculated "adequacy" as the percentage of the prescribed energy or protein goal delivered by enteral nutrition (EN), parenteral nutrition (PN), and total nutrition (EN + PN). Based on the days required to reach 60% energy or protein adequacy after PICU admission, we categorized patients into 3 groups: early (<= 3 d), pragmatic (4 to 7 d), and late (more than 7 d). The primary outcome was 60-d all-cause mortality; secondary outcomes were the incidence of acquired infections and 28-d ventilator-free days (VFDs). Results: From 77 participating PICUs. 1844 patients, with a median age of 1.64 y (IQR, 0.47-7.05), were included; the 60-d mortality rate was 5.3% (n = 97). The average adequacies of delivery via EN + PN was 49% (IQR, 26-70) for energy and 66% (IQR, 44-89) for protein. In multivariable models adjusted for confounders, mortality was significantly lower in patients who achieved targets within 7 d. for energy (adjusted HR, 0.48; 95% CI: 0.28-0.82; P = 0.007) or protein (adjusted HR, 0.55; 95% CI: 0.33-0.94: P = 0.027) delivery. There were no clinically significant differences in infections or VFDs between groups. Conclusions: Achieving 60% of energy or protein delivery targets within the first 7 d after PICU admission is associated with lower 60-d mortality in mechanically ventilated children, and is not associated with a greater incidence of infections or a reduction in VFDs compared to later achievement of targets.
引用
收藏
页码:1859 / 1867
页数:9
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