| Background:Nutritional support is an important component of the treatment of children receiving mechanical ventilation(MV)in the Pediatric Intensive Care Unit(PICU),and untimely or inadequate energy and protein supplies during PICU stay can lead to poor clinical outcomes.Providing timely and adequate nutritional support to children with MV is essential to improve their clinical outcomes.The timing and amount of energy and protein supply during treatment of children with MV has been the subject of much debate in current research.Objectives:The objectives of this study were: 1)To describe the current status of nutritional support in children receiving MV in the PICU.2)Analysis of the impact of energy and protein adequacy on the clinical outcome of MV in PICU children.3)Analyze the effect of reaching energy and protein goals at different times on clinical outcomes in children treated with MV in the PICU.Methods:This study is a prospective cohort study of children treated with MV enrolled in the PICU of the First Hospital of Jilin University from November 2020 to January 2022.To assess nutritional risk in children treated with MV,we used three different nutritional risk screening scales and collected anthropological,clinical,and nutritional questionnaires from the children to assess nutritional status.Daily energy and protein intake was recorded in the PICU for 10 days and ’adequacy’ was calculated as the percentage of actual energy or protein relative to the target energy or protein.Children were divided into 3 groups: early(1-3 days),middle(4-7 days),and late(>7 days),which based on the number of days required for reaching 2/3 of energy or protein goals.We analyzed the effect of energy,protein adequacy,and time to target on the length of hospital stay,length of PICU stay,duration of MV,morbidity,mortality,and incidence of hospital-acquired infections.Result:1.There were 156 children included,of which 26(16.7%)were malnourished.A Screening Tool for Risk of Impaired Nutritional Status and Growth(STRONGkids)was used to identify 35 cases(22.4%)at high risk,70 cases(44.9%)at moderate risk and 51cases(32.7%)at low risk.The Pediatric Yorkhill Malnutrition Score(PYMS)and the Screening Tool for the Assessment of Malnutrition in Pediatrics(STAMP)scales were also used to assess the risk of malnutrition,The STRONGkids had better discrimination power(kappa 0.795,P=0.005)when the three scales were analysed for consistency.The mean energy intake was 23.9(18.3,32.6)kcal/kg/d and the mean protein intake was 0.7(0.5,1.0)g/kg/d,with a median days to reach 2/3 of target energy and protein of 6.0(4.0,9.0)and 7.0(4.0,10.0)d,respectively;energy and protein adequacy during the first 7 days of MV was53.2(41.4,67.8)and 47.1(35.2,66.9).2.At the end of the first week of MV,44 cases had sufficient energy and 112 cases had insufficient energy.Meanwhile,39 cases had sufficient protein and 117 cases had insufficient protein.There was a significant difference in the pediatric risk of mortalityⅢscore(PRISMⅢ)between the two groups(P <0.001).The PRISMIII scores of the two groups were 6.0(4.0,14.0)and 15.0(9.3,19.8)respectively.Protein sufficiency and protein insufficiency were 6.0(4.0,15.0)and 15.0(8.0,19.8),respectively.The length of hospital stay and length of PICU stay in the energy and protein sufficient group were significantly shorter than those in the insufficient group.There were significant differences in the length of hospital stay,length of PICU stay,duration of MV,and mortality between the energy and protein sufficient and insufficient groups(P<0.05).There was no statistically significant difference in the incidence of hospital-acquired infections(P=0.172).3.There were 37 cases in the early energy group,52 cases in the middle group and 67 cases in the late group,and 35 cases in the early protein group,44 cases in the middle group and 77 cases in the late group.Mean energy and protein intake,energy and protein adequacy,and time to energy and protein adherence at the end of the first week were statistically different(P<0.001)for the energy and protein adherence group.There were significant differences(P<0.001)between the early and middle groups and the late group in terms of the length of hospital stay,duration of MV,and mortality.Length of PICU stay and the incidence of hospital-acquired infections did not differ significantly between the protein-adequate groups(P > 0.05).Conclusion:1.Most children treated with MV are malnourished at admission,and the Strong Child Nutrition Screening Scale helps identify children at nutritional risk early.2.Achieving energy and protein goals during the first week of PICU stay in children treated with MV remains difficult.Achieving energy and/or protein adequacy during the first week in the PICU can reduce the length of stay,the length of MV,and the morbidity and mortality rate.3.Achieving energy and protein goals during the PICU stay,especially in the early and middle stages,can result in better energy and protein adequacy,as well as reduced length of stay,length of MV,and reduced morbidity and mortality. |
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