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Crit Care. 2018 Sep 24;22(1):229. doi: 10.1186/s13054-018-2159-x.

Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals.

Xing J1, Zhang Z2, Ke L1, Zhou J1, Qin B3, Liang H4, Chen X5, Liu W6, Liu Z7, Ai Y8, Wang D9, Wang Q10, Zhou Q11, Zhang F12, Qian K13, Jiang D14, Zang B15, Li Y16, Huang X17, Qu Y18, Xie Y19, Xu D20, Zou Z21, Zheng X22, Liu J23, Guo F24, Liang Y25, Sun Q26, Gao H27, Liu Y28, Chang P29, Ceng A30, Yang R31, Yao G32, Sun Y33, Wang X34, Zhang Y35, Wen Y36, Yu J37, Sun R38, Li Z39, Yuan S40, Song Y41, Gao P42, Liu H43, Zhang Z44, Wu Y45, Ma B46, Guo Q47, Shan F48, Yang M49, Li H50, Li Y51, Lu W52, Wang L53, Qian C54, Wang Z55, Lin J56, Zhang R57, Wan P58, Peng Z59, Gong Y60, Huang L61, Wu G62, Sun J63, Deng Y64, Shi D35, Zhou L65, Zhou F66, Shi Q67, Guo X68, Liu X69, Wu W70, Meng X71, Li L72, Chen W73, Li S74, Wan X75, Chao Z76, Zhang A77, Gu L78, Chen W79, Wu J80, Zhou L81, Zhang Z82, Weng Y83, Feng Y84, Yang C85, Feng Y86, Zhao S87, Tong F88, Hao D89, Han H90, Fu B91, Gong C92, Li Z93, Hu K94, Kou Q95, Zhang H96, Liu J97, Fan C98, Zhou X99, Chen X100, Sun J101, Zhou X102, Song B103, Sun C104, Zhao L105, Dong X106, Zhang L107, Tong D108, Pan Z109, Cai C110, Wang D111, Dong Y112, Gong Y113, Wu Z114, Meng X115, Wang P116, Li W117.

Author information

1
Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002, China.
2
Department of emergency medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
3
Henan Provincial People's Hospital, Zhengzhou, China.
4
Zhongshan People's Hospital, Zhongshan, China.
5
Shandong University Qilu Hospital, Jinan, China.
6
Changzhou No.2 People's Hospital affiliated to Nanjing Medical University, Nanjing, China.
7
Jilin University First Hospital, Changchun, China.
8
Xiangya Hospital Central South University, Changsha, China.
9
Guizhou Medical University affiliated hospital, Guiyang, China.
10
Wuxi People's Hospital, Wuxi, China.
11
Hubei Provincial People's Hospital, Wuhan, China.
12
Tai'an Central Hospital, Tai'an, China.
13
First Affiliated Hospital of Nanchang University, Nanchang, China.
14
Third Military Medical University Daping Hospital, Chongqing, China.
15
China Medical University Second Affiliated Hospital, Shenyang, China.
16
Guangzhou Medical University First Affiliated Hospital, Guangzhou, China.
17
Sichuan Provincial People's Hospital, Chengdu, China.
18
Qingdao Municipal Hospital Group, Qingdao, China.
19
Jining First People's Hospital, Jining, China.
20
Guangzhou First Municipal People's Hospital, Guangzhou, China.
21
Xiehe Affiliated Hospital of Fujian Medical University, Fuzhou, China.
22
Dazhou Central Hospital, Dazhou, China.
23
Inner Mongolia People's Hospital, Huhehaote, China.
24
Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China.
25
Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Qingdao, China.
26
Tianjing People's Hospital, Tianjin, China.
27
Tianjing First Central Hospital, Tianjin, China.
28
Tangshan Gongren Hospital, Tangshan, China.
29
Southern Medical University Zhujiang Hospital, Guangzhou, China.
30
North China University of Science and Technology Affiliated Hospital, Tangshan, China.
31
Dalian Central Hospital, Dalian, China.
32
Peking University Third Hospital, Beijing, China.
33
Anhui Medical University Second Affiliated Hospital, Hefei, China.
34
Wenzhou Medical University First Affiliated Hospital, Wenzhou, China.
35
Shanxi Provincial People's Hospital, Taiyuan, China.
36
Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China.
37
Second Affiliated Hospital of Dalian Medical University, Dalian, China.
38
Zhengzhou University First Affiliated Hospital, Zhengzhou, China.
39
First People's Hospital of Kunming, Kunming, China.
40
Union Hospital Affiliated to Tongji Medical College of Huanzhong University of Science and Technology, Wuhan, China.
41
Xinjiang Medical University Affiliated First Hospital, Wulumuqi, China.
42
Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, China.
43
First Affiliated Hospital of Anhui Medical University, Hefei, China.
44
Yichang Central People's Hospital, Yichang, China.
45
Suzhou Municipal Hospital, Suzhou, China.
46
Jining Medical College Affiliated Hospital, Jining, China.
47
First Affiliated Hospital of Soochow University, Suzhou, China.
48
Qindao University Medical College Affiliated Hospital, Qindao, China.
49
Central South University Third Xiangya Hospital, Changsha, China.
50
401 Military Hospital of China, Qindao, China.
51
Changsha Central Hospital, Changsha, China.
52
Yijishan Hospital of Wannan Medical College, Wuhu, China.
53
Shanxi Medical University First Affiliated Hospital, Taiyuan, China.
54
Kuming Medical University First Affiliated Hospital, Kuming, China.
55
Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China.
56
First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
57
Zibo Central Hospital, Zibo, China.
58
First People's Hospital of Yichang, Yichang, China.
59
Wuhan University Zhongnan Hospital, Wuhan, China.
60
Wenzhou Medical University Second Affiliated Hospital, Wenzhou, China.
61
Shantou University Medical College First Affiliated Hospital, Shantou, China.
62
Zhongnan University Xiangya Second Hospital, Changsha, China.
63
Yunnan Second People's Hospital, Kunming, China.
64
Yancheng First People's Hospital, Yancheng, China.
65
First People's Hospital of Foshan, Foshan, China.
66
Chongqing Medical University First Affiliated Hospital, Chongqing, China.
67
Xi'an Jiao Tong University First Affiliated Hospital, Xi'an, China.
68
Beijing Wujing General Hospital, Beijing, China.
69
Shenzhen People's Hospital, Shenzhen, China.
70
Shanxi Dayi Hospital of Shanxi Academy of Medical Science, Taiyuan, China.
71
254 Military Hospital of China, Tianjin, China.
72
Qingdao University Affiliated Hospital, Qingdao, China.
73
Linhai First People's Hospital, Linhai, China.
74
Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
75
First Affiliated Hospital of Dalian Medical University, Dalian, China.
76
Beijing Chaoyang Hospital, Beijing, China.
77
Chongqing Medical University Second Affiliated Hospital, Chongqing, China.
78
People's Hospital of Yuxi City, Yuxi, China.
79
Shijitan Hospital of Capital Medical University, Beijing, China.
80
Shenzhen Nanshan People's Hospital, Shenzhen, China.
81
Affiliated Hospital of Inner Mongolia Medical College, Huhehaote, China.
82
Benq Hospital, Nanjing, China.
83
Luhe Hospital, Beijing, China.
84
Beijing Jingmei Group General Hospital, Beijing, China.
85
Jiangxi Provincial People's Hospital, Nanchang, China.
86
Jinan University First Affiliated Hospital, Jinan, China.
87
General Hospital of Rocket Army, Beijing, China.
88
Hebei Medical University Second Affiliated Hospital, Shijiazhuang, China.
89
Binzhou Medical College Affiliated Hospital, Binzhou, China.
90
Chinese PLA General Hospital, Beijing, China.
91
Yantai Mountain Hospital, Yantai, China.
92
Tianjing Hospital of ITCWM Nankai Hospital, Tianjing, China.
93
Hunan Provincial People's Hospital, Changsha, China.
94
People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
95
Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, China.
96
China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China.
97
Wuhan General Hospital of Guangzhou Military Region, Wuhan, China.
98
First People's Hospital of Yunnan, Kunming, China.
99
Xinjiang Military General Hospital, Wulumuqi, China.
100
Miyun Hospital of Beijing, Beijing, China.
101
Luoyang Central Hospital, Luoyang, China.
102
Huairou First Hospital of Beijing, Beijing, China.
103
Military General Hospital of Beijing PLA, Beijing, China.
104
Guangdong Provincial People's Hospital, Guangzhou, China.
105
Guangdong Second TCM Hospital, Guangzhou, China.
106
Beijing Hospital of TCM, Beijing, China.
107
Anhui Provincial Hospital, Hefei, China.
108
Shenyang First People's Hospital, Shenyang, China.
109
Guangzhou Military General Hospital, Guangzhou, China.
110
Sun Yat-sen University First Affiliated Hospital, Guangzhou, China.
111
Tianjing Cancer Hospital, Tianjing, China.
112
Shanxi Cancer Hospital, Taiyuan, China.
113
Nanchang University Second Affiliated Hospital, Nanchang, China.
114
Beijing University of Chinese Medicine Affiliated Dongfang Hospital, Beijing, China.
115
Shenzhen Second People's Hospital, Shenzhen, China.
116
Chendu Fifth People's Hospital, Chendu, China.
117
Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002, China. njzy_pancrea@163.com.

Abstract

BACKGROUND:

There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery.

METHODS:

This cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained.

RESULTS:

A total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2-19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2-3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353-0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008-0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient - 0.002, 95% CI - 0.008 to - 0.001; p = 0.024) and male gender (coefficient - 0.144, 95% CI - 0.203 to - 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2-3 was associated with lower EN proportion (coefficient - 0.206, 95% CI - 0.273 to - 0.139; p < 0.001).

CONCLUSIONS:

The study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.

KEYWORDS:

Cross-sectional study; Enteral feeding; Intensive care units

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