[Influence of enteral nutrition initiation timing on curative effect and prognosis of acute respiratory distress syndrome patients with mechanical ventilation]

Yan Guo, Jing Cheng, Yongjiang Li
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2018, 30 (6): 573-577

OBJECTIVE: To explore the effect of enteral nutrition (EN) initiation time on the treatment and prognosis of acute respiratory distress syndrome (ARDS) patients with mechanical ventilation.

METHODS: A retrospective study was conducted. 116 adult ARDS patients with mechanical ventilation admitted to the intensive care unit (ICU) of the Sixth Division Hospital of Xinjiang from January 2016 to December 2017 were enrolled. There was no difference in gender, age, acute physiology and chronic health evaluation II (APACHE II) at admission. Patients were divided into early enteral nutrition group (E-EN group, 66 cases, starting EN within 48 hours) and late enteral nutrition group (L-EN group, 50 cases, starting EN after 7 days later) according to the EN initiation time. Both groups of patients achieved the standard nutrition after 3-5 days of EN. Nutritional indicators [albumin (ALB), pre-albumin (PA)], liver function [total bilirubin (TBIL)], infection index [procalcitonin (PCT)], insulin dosage, respiratory mechanics and pulmonary function [airway peak pressure (PIP), airway plateau pressure (Pplat), mean airway pressure (MPaw), effective static total compliance (Cst), oxygenation index (PaO2 /FiO2 )], critical scores [APACHE II, multiple organ dysfunction score (MODS), Murray lung injury score, and systemic inflammatory response syndrome (SIRS) score], duration of mechanical ventilation, the length of ICU stay, incidence of multiple organ dysfunction syndrome, 14-day mortality, and ICU hospitalization expenses were collected before treatment and 1, 3, 7, 10, 14 days after treatment.

RESULTS: There was no difference in biochemical indicators, respiratory mechanics, pulmonary function, or critical scores between the two groups before ICU treatment. Compared with before treatment, ALB and PA were significantly increased, TBIL and MPaw were significantly decreased, insulin dosage was significantly decreased, PIP, Pplat, MPaw were significantly decreased, Cst and PaO2 /FiO2 were significantly increased, and the critical scores were significantly decreased. Compared with L-EN group, E-EN group had lower TBIL and PCT after treatment [TBIL (μmol/L): 13.21±1.03 vs. 29.02±1.38, PCT (ng/L): 5.36±1.58 vs. 11.33±1.95], lower insulin dose (U: 16.37±1.01 vs. 27.01±1.92), lower PIP, Pplat, MPaw [PIP (cmH2 O, 1 cmH2 O = 0.098 kPa): 17.7±3.5 vs. 22.5±4.3, Pplat (cmH2 O): 10.5±1.4 vs. 15.6±1.2, MPaw (cmH2 O): 5.5±0.7 vs. 8.2±0.8], higher Cst, PaO2 /FiO2 [Cst (mL/cmH2 O): 128.6±16.5 vs. 93.7±11.9, PaO2 /FiO2 (mmHg, 1 mmHg = 0.133 kPa): 242.9±27.9 vs. 188.6±25.9, all P < 0.05], however, there was no significant difference in ALB, PA and critical care scores [ALB (g/L): 37.09±1.49 vs. 35.88±1.77, PA (mg/L): 387.29±10.93 vs. 369.27±11.44, APACHE II: 13.9±3.5 vs. 14.5±5.0, Murray: 5.6±0.9 vs. 5.2±1.4, MODS: 1.1±0.4 vs. 1.2±0.3, SIRS: 2.9±0.5 vs. 3.1±0.9, all P > 0.05]. Compared with L-EN group, incidence of multiple organ dysfunction syndrome was significantly decreased in E-EN group [31.8% (21/66) vs. 48.0% (24/50), P < 0.05], duration of mechanical ventilation and the length of ICU stay were significantly shortened (days: 5.5±0.7 vs. 9.2±0.8, 8.6±1.5 vs. 18.3±1.9, both P < 0.05), ICU hospitalization expenses was significantly reduced (10 000 yuan: 6.324±0.009 vs. 11.419±0.010, P < 0.05), but there was no significantly difference in 14-day mortality between two groups [15.2% (10/66) vs. 16.0% (8/50), P > 0.05].

CONCLUSIONS: Early and reasonable application of EN supportive therapy can improve the clinical efficacy of ARDS patients, reduce the incidence of infection, make it easier to control blood sugar, improve lung function, shorten the duration of mechanical ventilation and the length of ICU stay, and reduce hospitalization expenses. However, no significant difference has been found in the prognosis of the recent 14 days.

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