Time to achieve delivery of nutrition targets is associated with clinical outcomes in critically ill children
被引:24
|
作者:
Bechard, Lori J.
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机构:Boston Childrens Hosp, Dept Anesthesiol Crit Care & Pain Med, Boston, MA 02115 USA
Bechard, Lori J.
Staffa, Steven J.
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机构:Boston Childrens Hosp, Dept Anesthesiol Crit Care & Pain Med, Boston, MA 02115 USA
Staffa, Steven J.
Zurakowski, David
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机构:Boston Childrens Hosp, Dept Anesthesiol Crit Care & Pain Med, Boston, MA 02115 USA
Zurakowski, David
Mehta, Nilesh M.
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机构:
Boston Childrens Hosp, Dept Anesthesiol Crit Care & Pain Med, Boston, MA 02115 USABoston Childrens Hosp, Dept Anesthesiol Crit Care & Pain Med, Boston, MA 02115 USA
Mehta, Nilesh M.
[1
]
机构:
[1] Boston Childrens Hosp, Dept Anesthesiol Crit Care & Pain Med, Boston, MA 02115 USA
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.
机构:
Natl Univ Malaysia, Fac Hlth Sci, Dietet Programme, Sch Healthcare Sci, Kuala Lumpur 50300, MalaysiaNatl Univ Malaysia, Fac Hlth Sci, Dietet Programme, Sch Healthcare Sci, Kuala Lumpur 50300, Malaysia
Abdul Manaf, Zahara
Kassim, Norasimah
论文数: 0引用数: 0
h-index: 0
机构:
Hosp Kuala Lumpur, Dietet & Food Serv Dept, Kuala Lumpur, MalaysiaNatl Univ Malaysia, Fac Hlth Sci, Dietet Programme, Sch Healthcare Sci, Kuala Lumpur 50300, Malaysia
Kassim, Norasimah
Hamzaid, Nur Hana
论文数: 0引用数: 0
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机构:
Natl Univ Malaysia, Fac Hlth Sci, Dietet Programme, Sch Healthcare Sci, Kuala Lumpur 50300, MalaysiaNatl Univ Malaysia, Fac Hlth Sci, Dietet Programme, Sch Healthcare Sci, Kuala Lumpur 50300, Malaysia
Hamzaid, Nur Hana
Razali, Nurul Huda
论文数: 0引用数: 0
h-index: 0
机构:
Natl Univ Malaysia, Fac Hlth Sci, Dietet Programme, Sch Healthcare Sci, Kuala Lumpur 50300, MalaysiaNatl Univ Malaysia, Fac Hlth Sci, Dietet Programme, Sch Healthcare Sci, Kuala Lumpur 50300, Malaysia
机构:
Boston Childrens Hosp, Dept Cardiovasc Crit Care Nursing, Boston, MA 02115 USABoston Childrens Hosp, Dept Cardiovasc Crit Care Nursing, Boston, MA 02115 USA
Hamilton, Susan
McAleer, Diane M.
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机构:
Boston Childrens Hosp, Dept Cardiovasc Crit Care Nursing, Boston, MA 02115 USABoston Childrens Hosp, Dept Cardiovasc Crit Care Nursing, Boston, MA 02115 USA
McAleer, Diane M.
Ariagno, Katelyn
论文数: 0引用数: 0
h-index: 0
机构:
Boston Childrens Hosp, Div Gastroenterol Hepatol & Nutr, Boston, MA 02115 USABoston Childrens Hosp, Dept Cardiovasc Crit Care Nursing, Boston, MA 02115 USA
Ariagno, Katelyn
Barrett, Megan
论文数: 0引用数: 0
h-index: 0
机构:
Boston Childrens Hosp, Dept Cardiovasc Crit Care Nursing, Boston, MA 02115 USABoston Childrens Hosp, Dept Cardiovasc Crit Care Nursing, Boston, MA 02115 USA
Barrett, Megan
Stenquist, Nicole
论文数: 0引用数: 0
h-index: 0
机构:
Boston Childrens Hosp, Dept Anesthesiol Pain & Perioperat Med, Boston, MA 02115 USABoston Childrens Hosp, Dept Cardiovasc Crit Care Nursing, Boston, MA 02115 USA
Stenquist, Nicole
Duggan, Christopher P.
论文数: 0引用数: 0
h-index: 0
机构:
Boston Childrens Hosp, Div Gastroenterol Hepatol & Nutr, Boston, MA 02115 USABoston Childrens Hosp, Dept Cardiovasc Crit Care Nursing, Boston, MA 02115 USA
Duggan, Christopher P.
Mehta, Nilesh M.
论文数: 0引用数: 0
h-index: 0
机构:
Boston Childrens Hosp, Dept Anesthesiol Pain & Perioperat Med, Boston, MA 02115 USABoston Childrens Hosp, Dept Cardiovasc Crit Care Nursing, Boston, MA 02115 USA
机构:
Childrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Childrens Hosp Colorado, Dept Pediat, Aurora, CO 80045 USAChildrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Kaufman, Jon
Vichayavilas, Piyagarnt
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Childrens Hosp Colorado, Clin Nutr, Aurora, CO 80045 USAChildrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Vichayavilas, Piyagarnt
Rannie, Michael
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Colorado, Clin Informat, Aurora, CO 80045 USAChildrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Rannie, Michael
Peyton, Christine
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Univ Colorado, Sch Nursing, Aurora, CO USAChildrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Peyton, Christine
Carpenter, Esther
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Univ Colorado, Sch Nursing, Aurora, CO USAChildrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Carpenter, Esther
Hull, Danielle
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Colorado, Clin Nutr, Aurora, CO 80045 USAChildrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Hull, Danielle
Alpern, Jennifer
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Univ Colorado, Sch Nursing, Aurora, CO USAChildrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Alpern, Jennifer
Barrett, Cindy
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Childrens Hosp Colorado, Dept Pediat, Aurora, CO 80045 USAChildrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Barrett, Cindy
da Cruz, Eduardo M.
论文数: 0引用数: 0
h-index: 0
机构:
Childrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
Childrens Hosp Colorado, Dept Pediat, Aurora, CO 80045 USAChildrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
da Cruz, Eduardo M.
Roosevelt, Genie
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h-index: 0
机构:
Denver Hlth Hosp Author, Dept Emergency Med, Denver, CO USAChildrens Hosp Colorado, Inst Heart, Aurora, CO 80045 USA
机构:
Ewha Womans Univ, Grad Sch Converging Clin & Publ Hlth, Seoul, South Korea
Ewha Womans Univ, Mokdong Hosp, Dept Pharm, Seoul, South KoreaEwha Womans Univ, Grad Sch Converging Clin & Publ Hlth, Seoul, South Korea
Lee, Jeong Shin
Kang, Ji Eun
论文数: 0引用数: 0
h-index: 0
机构:
Ewha Womans Univ, Div Life & Pharmaceut Sci, Grad Sch, Seoul, South KoreaEwha Womans Univ, Grad Sch Converging Clin & Publ Hlth, Seoul, South Korea
Kang, Ji Eun
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机构:
Park, So Hyun
Jin, Hye Kyung
论文数: 0引用数: 0
h-index: 0
机构:
Ewha Womans Univ, Coll Pharm, 52 Ewhayeodae Gil, Seoul 03760, South KoreaEwha Womans Univ, Grad Sch Converging Clin & Publ Hlth, Seoul, South Korea
Jin, Hye Kyung
论文数: 引用数:
h-index:
机构:
Jang, Soo Min
Kim, Sun Ah
论文数: 0引用数: 0
h-index: 0
机构:
Ewha Womans Univ, Mokdong Hosp, Dept Pharm, Seoul, South KoreaEwha Womans Univ, Grad Sch Converging Clin & Publ Hlth, Seoul, South Korea
Kim, Sun Ah
Rhie, Sandy Jeong
论文数: 0引用数: 0
h-index: 0
机构:
Ewha Womans Univ, Grad Sch Converging Clin & Publ Hlth, Seoul, South Korea
Ewha Womans Univ, Mokdong Hosp, Dept Pharm, Seoul, South Korea
Ewha Womans Univ, Div Life & Pharmaceut Sci, Grad Sch, Seoul, South Korea
Ewha Womans Univ, Coll Pharm, 52 Ewhayeodae Gil, Seoul 03760, South KoreaEwha Womans Univ, Grad Sch Converging Clin & Publ Hlth, Seoul, South Korea
机构:
Harvard Univ, Sch Med, Boston, MA USA
Boston Childrens Hosp, Dept Anesthesiol Perioperat & Pain Med, Div Crit Care Med, Boston, MA USAHarvard Univ, Sch Med, Boston, MA USA
Mehta, Nilesh M.
[J].
NEW ENGLAND JOURNAL OF MEDICINE,
2016,
374
(12):
: 1190
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