Intravenous overload of fluids and sodium may contribute to the lower infusion of enteral nutrition in critically ill patients

ABSTRACT Objective: To evaluate the effects of intravenous infusion of fluids and sodium on the first day of admission on infusion of enteral nutrition in the first 5 days in intensive care patients. Methods: A prospective cohort study was conducted with critical nonsurgical patients admitted for at least 5 days who were on mechanical ventilation and receiving enteral nutrition. The amount of intravenous fluids and sodium infused on the first day and the volume of enteral nutrition infused in the first 5 days were investigated. The volume of intravenous fluids > 35mL/kg or ≤ 35mL/kg of body weight and sodium (above or below the 25th percentile) infused on the first day was compared with infused enteral nutrition. Results: A total of 86 patients were studied, with a mean (± standard deviation) of 65 ± 17 years, of which 54.7% were female. On the first day, 3,393.7 ± 1,417.0mL of fluid (48.2 ± 23.0mL/kg) and 12.2 ± 5.1g of sodium were administered. Fifty-eight (67.4%) patients received more than 35mL/kg of fluids. In 5 days, 67 ± 19.8% (2,993.8 ± 1,324.4mL) of the prescribed enteral nutrition was received. Patients who received > 35mL/kg of intravenous fluids also received less enteral nutrition in 5 days (2,781.4 ± 1,337.9 versus 3,433.6 ± 1,202.2mL; p = 0.03) versus those who received ≤ 35mL/kg. Patients with intravenous sodium infusion above the 25th percentile (≥ 8.73g) on the first day received less enteral nutrition volume in 5 days (2,827.2 ± 1,398.0 versus 3,509.3 ± 911.9mL; p = 0.02). Conclusion: The results of this study support the assumption that the administration of intravenous fluids > 35mL/kg and sodium ≥ 8.73g on the first day of hospitalization may contribute to the lower infusion of enteral nutrition in critically ill patients.

摘要
研究目的：评估重症监护患者住院首日静脉输注液体与钠的剂量，对其前5天肠内营养（enteral nutrition）输注量的影响。
研究方法：本研究为前瞻性队列研究（prospective cohort study），纳入需机械通气（mechanical ventilation）、接受肠内营养且住院时长至少5天的非外科重症患者。分析患者住院首日的静脉补液量、钠摄入量，以及前5天的肠内营养输注量；将首日静脉补液量＞35mL/kg体重与≤35mL/kg体重、首日静脉钠摄入量高于或低于25百分位数（percentile）的患者，分别对比其肠内营养输注量。
研究结果：本研究共纳入86例患者，平均年龄（±标准差（standard deviation））为65±17岁，其中女性占比54.7%。住院首日，患者共接受静脉补液3393.7±1417.0mL（折合48.2±23.0mL/kg体重），钠摄入总量为12.2±5.1g。其中58例（67.4%）患者补液量＞35mL/kg体重。住院前5天，患者实际接受的肠内营养量为医嘱处方量的67±19.8%（折合2993.8±1324.4mL）。与补液量≤35mL/kg体重的患者相比，补液量＞35mL/kg体重的患者前5天肠内营养输注量更低（2781.4±1337.9mL vs 3433.6±1202.2mL；P=0.03）。住院首日静脉钠摄入量高于25百分位数（≥8.73g）的患者，其前5天肠内营养输注量亦更低（2827.2±1398.0mL vs 3509.3±911.9mL；P=0.02）。
研究结论：本研究结果支持下述假设：重症患者住院首日静脉补液量＞35mL/kg体重且钠摄入量≥8.73g，可能会降低其肠内营养输注量。