Email Alerts
RSS
Volume 37 Issue 9
Sep.  2021
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2021  >  37(9): 831-838
Pan YY,Xu SD,Fan YF,et al.Analysis of risk factors of early enteral nutrition intolerance in extremely severe burn patients[J].Chin J Burns,2021,37(9):831-838.DOI: 10.3760/cma.j.cn501120-20210511-00180.
Citation: Pan YY,Xu SD,Fan YF,et al.Analysis of risk factors of early enteral nutrition intolerance in extremely severe burn patients[J].Chin J Burns,2021,37(9):831-838.DOI: 10.3760/cma.j.cn501120-20210511-00180.
shu

Analysis of risk factors of early enteral nutrition intolerance in extremely severe burn patients

doi: 10.3760/cma.j.cn501120-20210511-00180

  • Department of Burns, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo 315010, China

Funds:

Public Health Key Discipline Project of Ningbo 2016020

Natural Science Foundation of Ningbo 2018A610369

More Information
    Abstract
  •   Objective  To explore the risk factors of early enteral nutrition intolerance in extremely severe burn patients.  Methods  A retrospective case-control study was performed. From January 2018 to December 2020, seventy-six adult patients with extremely severe burns who met the inclusion criteria were admitted to Hwa Mei Hospital of University of Chinese Academy of Sciences, including 55 males and 21 females, aged (45±11) years with burns of 62% (52%, 82%) total body surface area. Depending on the patient's tolerance to early enteral nutrition, they were divided into tolerance group (47 patients) and intolerance group (29 patients), and their clinical data were statistically analyzed, including age, sex, body mass index (BMI), underlying disease, total burn area, full-thickness burn area, abbreviated burn severity index (ABSI) score, implementation of mechanical ventilation on the day of admission, stable shock state, vomiting before feeding. The following data were recorded including the onset time, duration length, and frequency of enteral nutrition intolerance of patients in intolerance group, and the number of operations, the length of hospitalization, the occurrence of sepsis within 2 weeks after injury, the outcome, as well as the serum hypersensitive C-reactive protein (hs-CRP), albumin, fasting blood glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transpeptidase (γ-GT) on post burn day (PBD) 1, 5, 9, and 13 of patients in the two groups. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test to screen the related factors of early enteral nutrition intolerance of the patients. Binary univariate and multivariate logistic regression analysis were used to analyze the independent risk factors of early enteral nutrition intolerance of the patients.  Results  There were no statistically significant differences in age, sex, BMI, and percentage of underlying disease of patients between the two groups (P>0.05). The total burn area, full-thickness burn area, ABSI score, mechanical ventilation percentage on the day of admission, percentage of unstable shock period, percentage of vomiting before feeding of patients in intolerance group were significantly higher than those in tolerance group (Z=-4.559, -3.378, -4.067, χ2=18.375, 23.319, 8.339, P<0.01). In intolerance group, the onset time of intolerance was (9±4) d after injury, and the duration length was 4 (2, 6) d, with a total of 46 times occurred. Compared with tolerance group, the percentage of sepsis and mortality of patients in intolerance group were significantly higher within 2 weeks after injury (χ2=16.571, 12.665, P<0.01). The number of operation and length of hospitalization of patients in the two groups were similar (P>0.05); however the length of hospitalization of patients in the intolerance group was significantly more than that in tolerance group after excluding the death cases (Z=-2.266, P<0.05). On PBD 1, the level of fasting blood glucose and AST of patients in intolerance group were significantly higher than those in tolerance group (t=3.070, Z=-3.070, P<0.01). On PBD 5, the levels of hs-CRP, albumin, fasting blood-glucose, ALT, AST, and γ-GT of patients in the two groups were similar (P>0.05). On PBD 9, the level of hs-CRP of patients in intolerance group was significantly higher than that in tolerance group (t=2.836, P<0.01), and the levels of ALT and γ-GT of patients in intolerance group were significantly lower than those in tolerance group (Z=-3.932, -2.052, P<0.05 or P<0.01). On PBD 13, the level of hs-CRP of patients in intolerance group was significantly higher than that in tolerance group (t=3.794, P<0.01), and the levels of fasting blood glucose, ALT, and γ-GT of patients in intolerance group were significantly lower than those in tolerance group (t=-2.176, Z=-2.945, -2.250, P<0.05 or P<0.01). Binary univariate logistic regression analysis showed that total burn area, full-thickness burn area, ABSI score, implementation of mechanical ventilation on the day of admission, unstable shock period, vomiting before feeding, and fasting blood-glucose on PBD 1 of patients were related to early enteral nutrition intolerance (odds ratio=1.086, 1.052, 1.775, 9.167, 12.797, 10.125, 1.249, 95% confidence interval=1.045 - 1.129, 1.019 - 1.085, 1.320 - 2.387, 3.132 - 26.829, 4.199 - 39.000, 2.003 - 51.172, 1.066 - 1.464, P<0.01). Multivariate logistic regression analysis showed that the large total burn area, unstable shock period, vomiting before feeding, and high fasting blood-glucose on PBD 1 of patients were the independent risk factors of early enteral nutrition intolerance in patients (odds ratio=1.073, 6.390, 9.004, 1.246, 95% confidence interval=1.021 - 1.128, 1.527 - 26.734, 1.134 - 71.496, 1.007 - 1.540, P<0.05 or P<0.01).  Conclusions  The percentage of early enteral nutrition intolerance is very high in extremely severe burn patients, which is closely related to poor prognosis. Large total burn area, vomiting before feeding, unstable shock phase, high fasting glucose on PBD 1 of patients are the independent risk factors for early enteral nutrition intolerance in extremely severe burn patients. The benefits and risks should be carefully evaluated before starting enteral nutrition in such patients, and early enteral nutrition should not be blindly pursued.

     

    • FullText(HTML)
  • loading
    • References(33)
  • [1]
    MoreiraE,BurghiG,ManzanaresW.Update on metabolism and nutrition therapy in critically ill burn patients[J].Med Intensiva (Engl Ed),2018,42(5):306-316.DOI: 10.1016/j.medin.2017.07.007.
    [2]
    LavrentievaA,KontakiotisT,BitzaniM.Enteral nutrition intolerance in critically ill septic burn patients[J].J Burn Care Res,2014,35(4):313-318.DOI: 10.1097/BCR.0b013e3182a22403.
    [3]
    彭曦.烧伤临床营养新视角[J].中华烧伤杂志,2019,35(5):321-325.DOI: 10.3760/cma.j.issn.1009-2587.2019.05.001.
    [4]
    ClarkA,ImranJ,MadniT,et al.Nutrition and metabolism in burn patients[J/OL].Burns Trauma,2017,5:11[2021-05-11]. https://pubmed.ncbi.nlm.nih.gov/28428966/.DOI: 10.1186/s41038-017-0076-x.
    [5]
    WolfSE,JeschkeMG,RoseJK,et al.Enteral feeding intolerance: an indicator of sepsis-associated mortality in burned children[J].Arch Surg,1997,132(12):1310-1313; discussion 1313-1314.DOI: 10.1001/archsurg.1997.01430360056010.
    [6]
    GuoF,ZhouH,WuJ,et al.A prospective observation on nutrition support in adult patients with severe burns[J].Br J Nutr,2019,121(9):974-981.DOI: 10.1017/S0007114519000217.
    [7]
    武晓勇,李旭照,余鹏飞,等.重症患者喂养不耐受的研究进展[J].国际外科学杂志,2017,44(1):55-60.DOI: 10.3760/cma.j.issn.1673-4203.2017.01.019.
    [8]
    ViraniFR,PeeryT,RivasO,et al.Incidence and effects of feeding intolerance in trauma patients[J].JPEN J Parenter Enteral Nutr,2019,43(6):742-749.DOI: 10.1002/jpen.1469.
    [9]
    LiH,YangZ,TianF.Risk factors associated with intolerance to enteral nutrition in moderately severe acute pancreatitis: a retrospective study of 568 patients[J].Saudi J Gastroenterol,2019,25(6):362-368.DOI: 10.4103/sjg.SJG_550_18.
    [10]
    AzimA,HaiderAA,RheeP,et al.Early feeds not force feeds: enteral nutrition in traumatic brain injury[J].J Trauma Acute Care Surg,2016,81(3):520-524.DOI: 10.1097/TA.0000000000001089.
    [11]
    BartelsP,ThammOC,ElrodJ,et al.The ABSI is dead, long live the ABSI - reliable prediction of survival in burns with a modified Abbreviated Burn Severity Index[J].Burns,2020,46(6):1272-1279.DOI: 10.1016/j.burns.2020.05.003.
    [12]
    SingerP,BlaserAR,BergerMM,et al.ESPEN guideline on clinical nutrition in the intensive care unit[J].Clin Nutr,2019,38(1):48-79.DOI: 10.1016/j.clnu.2018.08.037.
    [13]
    罗高兴,彭毅志,庄颖,等.烧伤休克期有关补液公式的临床应用与评价[J]. 中华烧伤杂志, 2008, 24(4):248-250. DOI: 10.3760/cma.j.issn.1009-2587.2008.04.003.
    [14]
    GungabissoonU,HacquoilK,BainsC,et al.Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness[J].JPEN J Parenter Enteral Nutr,2015,39(4):441-448.DOI: 10.1177/0148607114526450.
    [15]
    严正,黄英姿,吕国忠,等.严重烧伤患者肠内营养不耐受的影响因素及与预后的相关性[J].广东医学,2016,37(4):567-569.
    [16]
    MontejoJC. Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study[J]. Crit Care Med, 1999, 27(8):1447-1453. DOI: 10.1097/00003246-199908000-00006.
    [17]
    MentecH,DupontH,BocchettiM,et al.Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications[J].Crit Care Med,2001,29(10):1955-1961.DOI: 10.1097/00003246-200110000-00018.
    [18]
    SavioRD,ParasuramanR,LoveslyD,et al.Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position[J].J Intensive Care Soc,2021,22(1):41-46.DOI: 10.1177/1751143719900100.
    [19]
    HuangHH,LeeYC,ChenCY.Effects of burns on gut motor and mucosa functions[J].Neuropeptides,2018,72:47-57.DOI: 10.1016/j.npep.2018.09.004.
    [20]
    LewisK,AlqahtaniZ,McintyreL,et al.The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials[J].Crit Care,2016,20(1):259.DOI: 10.1186/s13054-016-1441-z.
    [21]
    SierpEL,KurmisR,LangeK,et al.Nutrition andgastrointestinal dysmotility in critically ill burn patients: a retrospective observational study[J].JPEN J Parenter Enteral Nutr,2020,45(5):1052-1060.DOI: 10.1002/jpen.1979.
    [22]
    EworukeE,MajorJM,GilbertMcClain LI.National incidence rates for Acute Respiratory Distress Syndrome (ARDS) and ARDS cause-specific factors in the United States (2006-2014)[J].J Crit Care,2018,47:192-197.DOI: 10.1016/j.jcrc.2018.07.002.
    [23]
    GovilD, PalD. Gastrointestinal motility disorders in critically ill[J]. Indian J Crit Care Med, 2020, 24(Suppl 4):S179-182. DOI: 10.5005/jp-journals-10071-23614.
    [24]
    HeylandDK,OrtizA,StoppeC,et al.Incidence, risk factors, and clinical consequence of enteral feeding intolerance in the mechanically ventilated critically ill: an analysis of a multicenter, multiyear database[J].Crit Care Med,2021,49(1):49-59.DOI: 10.1097/CCM.0000000000004712.
    [25]
    HeW,WangY,WangP,et al.Intestinal barrier dysfunction in severe burn injury[J/OL].Burns Trauma,2019,7:24[2021-05-11].https://pubmed.ncbi.nlm.nih.gov/31372365.DOI: 10.1186/s41038-019-0162-3.
    [26]
    ZhuR, MaXC. Role of metabolic changes of mucosal layer in the intestinal barrier dysfunction following trauma/hemorrhagic shock[J].Pathol Res Pract,2018,214(11):1879-1884. DOI: 10.1016/j.prp.2018.08.023.
    [27]
    何振扬.2017 ESICM重症患者早期肠内营养指南解读[J/OL].中华重症医学电子杂志:网络版,2018,4(1):51-56.[2021-05-01].https://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjEwODE4Ehd6aHp6eXhkenp6LXdsYjIwMTgwMTAxMRoIZjU0M2g2OGg%3D.DOI: 10.3877/cma.j.issn.2096-1537.2018.01.011.
    [28]
    ReignierJ,Boisramé-HelmsJ,BrisardL,et al.Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2)[J].Lancet,2018,391(10116):133-143.DOI: 10.1016/S0140-6736(17)32146-3.
    [29]
    NguyenN,ChingK,FraserR,et al.The relationship between blood glucose control and intolerance to enteral feeding during critical illness[J].Intensive Care Med,2007,33(12):2085-2092.DOI: 10.1007/s00134-007-0869-7.
    [30]
    李雪,昝涛,殷宝月,等. 创伤后肠内营养喂养不耐受的影响因素分析[J/CD].心血管外科杂志:电子版,2019, 8(1):73-74. DOI: 10.3969/j.issn.2095-2260.2019.01.055.
    [31]
    郑忠骏,吴春双,徐善祥,等.连续血糖监测系统在危重患者中的准确性与预后评估价值[J].中华急诊医学杂志,2019,28(11):1426-1431.DOI: 10.3760/cma.j.issn.1671-0282.2019.11.018.
    [32]
    KrinsleyJS, PreiserJC. Is it time to abandon glucose control in critically ill adult patients?[J]. Curr Opin Crit Care,2019,25(4):299-306.DOI: 10.1097/MCC.0000000000000621.
    [33]
    LuM, ZuoY, GuoJ, et al. Continuous glucose monitoring system can improve the quality of glucose control and glucose variability compared with point-of-care measurement in critically ill patients: a randomized controlled trial[J].Medicine (Baltimore),2018,97(36):e12138.DOI: 10.1097/MD.0000000000012138.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(6)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (1746) PDF downloads(60) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return