Study On The Application Of Volume-based Infusion Plan In Enteralnutrition Support

Background The body of critically ill patients is often in a state of high catabolism and metabolism,with increased energy consumption.Adequate protein energy feeding is beneficial to prognosis and can effectively reduce the mortality rate of critically ill patients on mechanical ventilation.However,there are many factors in the ICU that lead to interruption of feeding and failure to achieve the target amount of feeding.Systematic evaluation found that frequent interruption during Enteral nutrition(EN)was mainly due to lack of scientific process management in feeding tube,inspection or operation,followed by high Gastric Residual Volume(GRV).EN the implementation of the traditional way is to nurse according to the daily energy requirements for the total capacity in the whole needed to complete goals within 24 h of total amount of fluid infusion Rate per hour,which is based on the speed of the infusion plan(Rate-based feeding,RBF),the model if due to any reason of unscheduled interruption infusion,restart again after infusion continues at the same rate of the original,and realize the interrupt infusion time window to capacity,insufficient feeding brought on by reductions in the total capacity of infusion.Another new model by nurse according to the daily energy requirements of the total capacity as throughout the 24 h needed to fulfill the goals of the infusion,with capacity of infusion purpose,based on the capacity of infusion plan(Volume-based feeding,VBF),if the feeding interrupt,infusion rate is then adjusted to compensate for insufficient to produce feed in the infusion interrupt time window,to achieve feeding capacity up to standard.In recent years,the effectiveness and safety of this model has remained controversial and is rarely used in clinical practice,with a worldwide report showing that VBF is used only 14 percent of all critically ill patients.In addition,previous VBF studies used routine GRV monitoring,which has been repeatedly confirmed that GRV monitoring is not a risk indicator of aspiration pneumonia,but will reduce the amount of feeding and increase the burden on nurses.In the case of irregular GRV monitoring,the feasibility and safety of the new scheme in China are still to be studied.Purpose Studied in this paper through the comparison of two kinds of infusion plan,the discussion is helpful to improve the critically ill patient clinical feeding effect of infusion solutions,as well as studying VBF application in domestic critically ill patient population in the feasibility and safety of gastrointestinal tolerance,and the nutritional status of patients and the impact of new infections,in order to establish suitable for domestic capacity plan based optimization process.Method In this study,200 patients who had started EN were enrolled in strict accordance with the inclusion and exclusion criteria by means of convenience sampling.Once the target rate was reached and tolerated,the patients were divided into the control group or the experimental group by random envelope method.RBF was used for EN in the control group,and VBF was used for EN in the experimental group.After the doctor ordered the total EN fluid volume for 24 h,the nurses in the control group continued to start EN at the same speed as before the interruption of infusion for any reason.Before the infusion was interrupted and restarted again,nurses in the experimental group needed to recalculate the infusion speed according to the remaining time and the amount of remaining nutrient solution.Both groups received routine nursing care for critically ill patients.General information,APACHE II score,Nutrition Risk Screening(NRS 2002)score,and EN initiation time of critically ill patients were collected before intervention.After intervention,patients were monitored for FI,new infection,albumin(g/L)differences at 3 and 7 days after initiation of EN,EN reaching the 60% calorie target within 7 days,and ICU hospitalization and mechanical ventilation duration.SPSS 20.0 statistical software was used to conduct statistical analysis on the data of 200 patients who completed the experiment(98 in the experimental group and 102 in the control group),and to evaluate the influence of VBF on FI,new infection,nutrition index,feeding standard,hospitalization in ICU and mechanical ventilation time of EN supported critically ill patients.Result There was a statistically significant difference between the two groups in EN reaching the 60% target caloric content within 7 days and albumin content on day 7(P<0.05).The incidence of diarrhea,abdominal distension,vomiting and other complications and the incidence of new infection in the experimental group were significantly lower than those in the control group,with statistically significant differences(P<0.05).There were no statistically significant differences in albumin content on day 1-3,28-day survival rate,ICU admission or mechanical ventilation duration between the two groups(P>0.05).Conclusion VBF in critically ill patients can shorten the number of days a patient has to reach the target caloric intake,reduce the incidence of EN related complications and reduce the incidence of new infections.This plan could promote the early achievement of energy supply targets for critically ill patients without extending the length of hospital stay for mechanical ventilation and intensive care units.