| Objective: Nutrition support therapy is an essential component in comprehensive treatment of intensive care unit(ICU).A multitude of evidence-based studies have confirmed that nutrition support is significant in improving the outcome for critically ill patients, including shortening the time of mechanical ventilation and hospitalization, decreasing the complications and mortality. Enteral nutrition(EN), as the best choice of nutrition support, has several irreplaceable advantages for gastrointestinal(GI) tract. It can provide trophic effects to maintain intestinal physiology, prevent gut villi atrophy, decrease intestinal permeability, stimulate intestinal perfusion to protect against ischemia- reperfusion injury, and preserve gut immunity through their effects on the gut-associated lymphoid tissue. Early research has shown that the provision of early EN could decrease the infectious complications. For many aspects of reasons in actual clinical practice, under feeding is frequent in ICU and has an influence on outcome in different degrees for critical illness. With the study of nutrition support in depth, the problems related GI dysfunction is paid more and more attention. In 2012, the Working Group on Abdominal Problems(WGAP) of the European Society of Intensive Care Medicine(ESICM) developed the definitions for acute gastrointestinal injury(AGI) with its four grades of severity, as well as for feeding intolerance syndrome and GI symptoms in intensive care patients. Apart from this, the guideline also put forward relative managements for each grade. The study is to describe current nutrition practices and assess “Acute gastrointestinal injury” evidence-based recommendations of the ESICM Working Group on Abdominal Problems in intensive care units in the local.Method: A nutrition questionnaire(Assessment of AGI and nutrition support in ICU setting of Hebei Province-case report form)was designed to record the performances of nutrition support daily in detail and twenty four ICUs from twenty one teaching tertiary general hospitals of Hebei Province participate in our study.Results: Patient characteristics and practice of nutrition support were recorded in case report forms. In general, only 45.3%(145/320)of patients were provided with EN in preference to parenteral nutrition(PN),the average time to start of EN was 17.5hrs(site average range, 5.0–50 hrs), while up to 34.1%(109/320)of patients were offered PN as their first choice and the average time to start of PN was 8.0 hrs(site average range, 3.0–20.0 hrs). Feeding intolerance occurred in 27.8%(89/320) of the enrolled population, the most common cause for that was abdominal distension. The use of motility agents and small bowel feeding in patients who had intolerance during the delivering of EN was just 29.7%(95/320) and 3.8%(12/320), respectively. Early percentage of nutrition received in average account for 48.7%(site average range, 26.4%–77.3%) of energy prescribed and 25.9%(site average range, 12.4%–45.3%) of protein prescribed, respectively. The best performing site in average calorie supplied daily was four times more than the worst site(1840.0±357.8kcal & 440.7±367.83kcal).The glutamine was used in 59.8%(70/117) of patients received PN, while including 24.3%(17/70) suffering from “Multiple organ dysfunction syndrome”. Besides, the mean daily glucose level was 6.6mmol/L(site average range, 5.5–7.4mmol/L).On the basis of recommendations for Acute gastrointestinal injury(AGI)of the ESICM Working Group on Abdominal Problems in 2011, we classified the patients who meet a criterion into four grades according to severity of gastrointestinal function and describe the performance on key nutrition practices of each grade. 64.7%(207/320)of patients have been assessed in terms of gastrointestinal function that were categorized four grades(Ⅰ,Ⅱ,Ⅲ and Ⅳ) based on severity. The proportion for each grade were 60.4%(125), 26.6%(55), 10.6%(22) and 2.4%(5) in turn. For the patients of AGI gradeⅠ, there were almost two-thirds(82/125) patients accepting early EN. Among the patients of AGI gradeⅡ, 54.5%(30 of 55 patients) and 3.6%(2 of 55 patients) used prokinetic therapy and postpyloric feeding. Up to 68.2%(15/22) of patients provided with PN in patients of AGI grade Ⅲ.Conclusions: Acute gastrointestinal injury is prevalent in critically ill patients but ignored frequently by clinical physicians. Despite some recommendations have been recommended strongly in a multitude of nutrition guidelines to direct practice, significant gap exists between actual clinical and guideline. |
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