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Title: Enteral nutrition preference in critical care: fibre-enriched or fibre-free?
Author: Yagmurdur H, Leblebici F.
Journal: Asia Pac J Clin Nutr; 2016 Dec; 25(4):740-746. PubMed ID: 27702716.
Abstract:
BACKGROUND AND OBJECTIVES: This study's main aim was to observe the effects of a fibre-enriched nutrition solution on requisite feeding volume, which is directly proportional to energy intake in mechanically ventilated patients with enteral nutrition. METHODS AND STUDY DESIGN: Some 120 patients who required mechanical ventilation and enteral nutrition with a nasogastric tube were studied. Upon ICU admission, the patient's age, gender, weight, height, comorbidities, diagnosis and APACHE II score were recorded. We assigned two diets to the patients randomly. The control group received the fibre-free nutrition solution. The study group, received the fibreenriched nutrition solution. Prescribed feeding volume and administered feeding volume, gastric residual volume (GRV), volume ratio (VR), diarrhoea score and gastrointestinal complications (GIC) were recorded, along with daily biochemistry. RESULTS: The two groups did not differ with respect to age, sex, weight, BMI, APACHE II score, target caloric intake or GRV (p>0.05). On days four and five, the study group had higher VR values (p<0.05). Seventy-one (59%) patients had at least one gastrointestinal complication; 44 (73%) of them were controls and 27 (45%) of them study patients. The most commonly observed GIC was diarrhoea. Thirty-eight patients had diarrhoea in control group, and twenty-two patients had diarrhoea in study group, and this difference was statistically significant (p<0.001). There were no significant differences between the groups about vomiting and regurgitation. CONCLUSIONS: We suggest that ICU staff initiate enteral nutrition with fibre-enriched formulas rather than fibre-free formulas to avoid frequent feeding interruptions that cause protein energy malnutrition in ICU patients. 背景与目的：本研究的主要目的是观察一个富含纤维营养液对必要给与量的影响，这与机械通气的肠内营养患者能量摄入成正比。研究设计与方法：对需要机械通气和肠内营养鼻饲管的120 例患者进行了研究。在进入ICU 前，记录患者的年龄、性别、体重、身高、疾病、诊断和APACHE II 评分。我们随机将患者分至两种饮食。对照组给予无膳食纤维营养液。研究组给与富含膳食纤维营养液。在每日生化检测时，记录处方量和实际给予量、胃残留量（GRV）、体积比（VR）、腹泻评分和胃肠道并发症（GIC）。结果：两组患者的年龄、性别、体重、BMI、APACHEⅡ评分、热量摄入或GRV 均无统计学意义（p>0.05）。在第4 和5 天时，研究组的VR（p<0.05）较高。71 （59%）例患者至少有1 种胃肠道并发症，其中对照组44 例（73%），研究组27 例（45%）。腹泻是最常见的GIC。对照组38 例、研究组22 例患者有腹泻（p<0.001）。两组间呕吐和反流的发生率无统计学意义。结论：我们建议，对ICU 患者启动肠内营养与富含膳食纤维的配方，而不是无膳食纤维配方，以避免频繁喂养中断导致蛋白质-能量营养不良。.

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