Effect of early enteral nutrition standardized treatment on blood glucose and prognosis in acute respiratory distress syndrome patients with mechanical ventilation / 中华危重病急救医学

ABSTRACT

Objective To study the effect of early entreat nutrition (EN) standardized treatment on optimization of blood glucose control and prognosis in acute respiratory distress syndrome (ARDS) patients with mechanical ventilation (MV). Methods Forty-two patients with MV of ARDS admitted to Huzhou First Municipal People's Hospital from April 2015 to March 2017 were enrolled. April 1st, 2016 was taken as the time node, the patients treated from April 1st, 2015 to March 31st, 2016 were assigned in the control group (n = 20), while the patients treated from April 1st, 2016 to March 31st, 2017 were included in the experimental group (n = 22). The patients in experimental group were given conventional treatment, in 24-48 hours after admission gastrointestinal decompression was stopped and early EN was begun through a nasointestinal tube; the patients in control group received conventional treatment and routine EN (given 48 hours after admission). The differences in nutritional support indexes, the blood glucose variability indexes and the prognostic related indicators were compared between the two groups. Results Compared with the control group, the initiation time for EN tolerance, first defecation time, time of reaching target feeding amount were significantly earlier in the early EN standardized treatment process management [time of initial EN tolerance (hours) 106.82±42.84 vs. 157.29±56.76, first defecation time (hours) 71.29±23.43 vs. 104.69±26.94, time of reaching target feeding amount (days) 6.24±1.25 vs. 9.86±2.36], the proportions of EN/EN+parenteral nutrition (PN) and the nasointestinal tube feeding reaching the standard on 7 days in experimental group were significantly increased [the proportion of EN/EN+PN98.69% vs. 78.69%, the nasointestinal tube feeding reaching standard 68.18% (15/22) vs. 45.00% (9/20)], average level of blood glucose (GLUave), maximum value of blood glucose (GLUmax), standard deviation of blood glucose (GLUsd), coefficient of variation of blood glucose (GLUcv), hyperglycemia incidence, incidence of multiple organ dysfunction syndrome (MODS), 28-day mortality were significantly decreased [GLUave (mmol/L) 9.4±2.6 vs. 11.5±3.9, GLUmax (mmol/L) 14.19±2.36 vs. 16.26±4.89, GLUsd (mmol/L) 4.86±1.27 vs. 6.87±2.46, GLUcv (49.86±6.32)% vs. (59.95±5.81)%, hyperglycemia incidence 59.09% (13/22) vs. 80.00% (16/20), incidence of MODS 59.09% (13/22) vs. 80.00% (16/20), 28-day mortality 36.36% (8/22) vs. 45.00% (9/20)], minimum value of blood glucose (GLUmin) was significantly increased (mmol/L 5.86±2.32 vs. 4.18±1.86), invasive MV time was significantly shorted (hours156.82±26.84 vs. 169.93±32.34) with statistically significant differences (all P < 0.05). Early EN could also improve the patient's pulmonary oxygenation function. Since 9 days of disease course, the oxygenation index (PaO2/FiO2) in the experimental group was significantly higher than that of the control group [mmHg (1 mmHg = 0.133 kPa) 256.97±18.63 vs. 239.82±21.72, P = 0.068], but there was no significant difference in the length of ICU stay (days 13.9±3.6 vs. 14.8±3.4, P > 0.05). Conclusion The early EN standardized treatment process management can improve the nutritional status, decrease blood sugar fluctuations, and further benefit the improvement of the prognosis of ARDS patients with MV.