Risk factors for gastrointestinal complications related to enteral nutrition in critically ill children
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2008
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Springer Nature
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López-Herce J, Santiago MJ, Sánchez C, Mencía S, Carrillo A, Vigil D. Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition. Eur J Clin Nutr. 2008 Mar;62(3):395-400. doi: 10.1038/sj.ejcn.1602710. Epub 2007 Feb 28. PMID: 17327861.
Abstract
Este estudio prospectivo observacional investigó los factores de riesgo de complicaciones gastrointestinales asociadas con la nutrición enteral transpilórica en niños críticamente enfermos. Se identificó que el shock, la administración de epinefrina a dosis superiores a 0.3 μg/kg/min y la hipofosfatemia fueron los factores más importantes asociados con estas complicaciones.
Objective: To study the risk factors for gastrointestinal complications related to enteral nutrition in critically ill children. Design: A prospective, observational study. Setting: Pediatric intensive care unit. Subjects: Five hundred and twenty-six critically ill children who received transpyloric enteral nutrition(TEN). Methods: Univariate and multivariate logistic regression analysis were used to identify risk factors for gastrointestinal complications. Results: Sixty six patients (11.5%) presented gastrointestinal complications, 33 (6.2%) abdominal distension and/or excessive gastric residue, 34 (6.4%) diarrhea, one gastrointestinal bleeding, three necrotizing enterocolitis and one duodenal perforation. Enteral nutrition was definitively suspended because of gastrointestinal complications in 11 (2.1%) patients. Fifty patients (9.5%) died. Gastrointestinal complications were more frequent in the patients who died. Death was related to complications of the nutrition in only one patient. The frequency of gastrointestinal complications was significantly higher in children with shock, acute renal failure, hypokalemia, hypophosphatemia and in those receiving dopamine, epinephrine and vecuronium. The stepwise multivariate logistic regression analysis showed that the most important factors associated with gastrointestinal complications were shock, epinephrine at a rate higher than 0.3 microg/kg/min and hypophosphatemia. Conclusions: The tolerance of TEN in critically ill children is good, although the incidence of gastrointestinal complications is higher in patients with shock, acute renal failure, hypokalemia, hypophosphatemia, and those receiving epinephrine, dopamine, and vecuronium.
Objective: To study the risk factors for gastrointestinal complications related to enteral nutrition in critically ill children. Design: A prospective, observational study. Setting: Pediatric intensive care unit. Subjects: Five hundred and twenty-six critically ill children who received transpyloric enteral nutrition(TEN). Methods: Univariate and multivariate logistic regression analysis were used to identify risk factors for gastrointestinal complications. Results: Sixty six patients (11.5%) presented gastrointestinal complications, 33 (6.2%) abdominal distension and/or excessive gastric residue, 34 (6.4%) diarrhea, one gastrointestinal bleeding, three necrotizing enterocolitis and one duodenal perforation. Enteral nutrition was definitively suspended because of gastrointestinal complications in 11 (2.1%) patients. Fifty patients (9.5%) died. Gastrointestinal complications were more frequent in the patients who died. Death was related to complications of the nutrition in only one patient. The frequency of gastrointestinal complications was significantly higher in children with shock, acute renal failure, hypokalemia, hypophosphatemia and in those receiving dopamine, epinephrine and vecuronium. The stepwise multivariate logistic regression analysis showed that the most important factors associated with gastrointestinal complications were shock, epinephrine at a rate higher than 0.3 microg/kg/min and hypophosphatemia. Conclusions: The tolerance of TEN in critically ill children is good, although the incidence of gastrointestinal complications is higher in patients with shock, acute renal failure, hypokalemia, hypophosphatemia, and those receiving epinephrine, dopamine, and vecuronium.
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El estudio es innovador al realizar un análisis prospectivo y observacional de los factores de riesgo asociados con las complicaciones gastrointestinales en niños críticamente enfermos. Este enfoque permite obtener evidencia sólida sobre los factores que aumentan el riesgo de complicaciones, lo que es crucial para optimizar la nutrición enteral en estos pacientes.