Comment optimiser la nutrition entérale du patient ventilé ?

Lavoisier - Tập 23 - Trang 450-457 - 2013
J. Reignier1, J. -B. Lascarrou1, J. -C. Lacherade1, K. Bachoumas1, G. Colin1, A. Yehia1
1Service de réanimation, CHD de la Vendée, La Roche sur Yon, France

Tóm tắt

La nutrition artificielle est une pierre angulaire de la prise en charge du patient traité par ventilation mécanique invasive. Les recommandations internationales préconisent d’instaurer la nutrition le plus précocement possible après l’admission et, en l’absence de contre-indication digestive formelle, de privilégier la voie entérale. Cependant, de nombreux facteurs concourent à entraver sa bonne administration. Parmi ceux-ci, l’intolérance digestive à la nutrition et la prévention de ses conséquences potentielles apparaissent régulièrement comme des obstacles fréquents. Cependant, la définition même et l’approche de l’intolérance digestive à la nutrition entérale doivent être reconsidérées. Les régurgitations et les vomissements ne semblent pas constituer un facteur source de complications significatives, notamment de pneumopathie acquise sous ventilation mécanique. Leur prévention et leur gestion ne doivent pas entraver à l’excès l’atteinte des objectifs nutritionnels. La surveillance du volume gastrique résiduel ne doit plus être réalisée en routine. En cas d’intolérance, l’administration d’un prokinétique gastrique doit précéder la diminution de la nutrition entérale qui ne doit être interrompue qu’en dernier recours, sauf signes de gravité ou orientant vers une cause organique qui nécessitera un traitement approprié et éventuellement de préférer la voie parentérale. L’utilisation d’un protocole prédéterminé, synthétisant les connaissances dans le domaine, adapté aux caractéristiques des patients accueillis dans l’unité et connu de tous les membres de l’équipe est un facteur favorisant l’atteinte des objectifs nutritionnels. Des travaux de recherche clinique en cours ou à venir devraient permettre de mieux étayer les futures recommandations dans le domaine de la nutrition artificielle du patient ventilé.

Tài liệu tham khảo

Lewis SJ, Egger M, Sylvester PA, et al (2001) Early enteral feeding versus’ nil by mouth’ after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 323:773–776 Rubinson L, Diette GB, Song X, et al (2004) Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med 32:350–357 Tsai JR, Chang WT, Sheu CC, et al (2011) Inadequate energy delivery during early critical illness correlates with increased risk of mortality in patients who survive at least seven days: a retrospective study. Clin Nutr 30:209–214 Villet S, Chiolero RL, Bollmann MD, et al (2005) Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 24:502–509 Heyland DK, Dhaliwal R, Drover JW, et al (2003) Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 27:355–373 Thuong M, Leteurtre S (2003) Experts recommendations of the Société de Réanimation de Langue Française. Enteral nutrition in critical care. Réanimation 12:350–354 Kreymann KG, Berger MM, Deutz NE, et al (2006) ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr 25:210–223 McClave SA, Martindale RG, Vanek VW, et al (2009) Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 33:277–316 Artinian V, Krayem H, DiGiovine B. (2006) Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest 129:960–967 De Jonghe B, Appere-De-Vechi C, Fournier M, et al (2001) A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Crit Care Med 29:8–12 Oldenburg WA, Lau LL, Rodenberg TJ, et al (2004) Acute mesenteric ischemia: a clinical review. Arch Intern Med 164:1054–1062 Elke G, Schadler D, Engel C, et al (2008) Current practice in nutritional support and its association with mortality in septic patients—results from a national, prospective, multicenter study. Crit Care Med 36:1762–1767 Rice TW, Swope T, Bozeman S, et al (2005) Variation in enteral nutrition delivery in mechanically ventilated patients. Nutrition 21:786–792 Adam S, Batson S (1997) A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK. Intensive Care Med 23:261–266 Binnekade JM, Tepaske R, Bruynzeel P, et al (2005) Daily enteral feeding practice on the ICU: attainment of goals and interfering factors. Crit Care 9:R218–R225 Heyland DK, Schroter-Noppe D, Drover JW, et al (2003) Nutrition support in the critical care setting: current practice in canadian ICUs—opportunities for improvement? JPEN J Parenter Enteral Nutr 27:74–83 Cahill NE, Murch L, Jeejeebhoy K, et al (2011) When early enteral feeding is not possible in critically ill patients: results of a multicenter observational study. JPEN J Parenter Enteral Nutr 35:160–168 Cahill NE, Dhaliwal R, Day AG, et al (2010) Nutrition therapy in the critical care setting: what is “best achievable” practice? An international multicenter observational study. Crit Care Med 38:395–401 Berger MM, Pichard C. (2012) Best timing for energy provision during critical illness. Crit Care 16:215 Stapleton RD, Jones N, Heyland DK (2007) Feeding critically ill patients: what is the optimal amount of energy? Crit Care Med 35:S535–S540 Dvir D, Cohen J, Singer P (2006) Computerized energy balance and complications in critically ill patients: an observational study. Clin Nutr 25:37–44 Krishnan JA, Parce PB, Martinez A, et al (2003) Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest 124:297–305 Casaer MP, Mesotten D, Hermans G, et al (2011) Early versus late parenteral nutrition in critically ill adults. N Engl J Med 365:506–517 Heidegger CP, Berger MM, Graf S, et al (2013) Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet 381:385–393 Rice TW, Wheeler AP, Thompson BT, et al (2012) Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA 307:795–803 Andrews PJ, Avenell A, Noble DW, et al (2011) Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients. BMJ 342:d1542 Heyland D, Muscedere J, Wischmeyer PE, et al (2013) A randomized trial of glutamine and antioxydants in critically ill patients. N Engl J Med 368:1489–1497 Palmer AJ, Ho CK, Ajibola O, et al (2013) The role of omega-3 fatty acid supplemented parenteral nutrition in critical illness in adults: a systematic review and meta-analysis. Crit Care Med 41:307–316 Mentec H, Dupont H, Bocchetti M, et al (2001) Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med 29:1955–1961 Ritz MA, Fraser R, Edwards N, et al (2001) Delayed gastric emptying in ventilated critically ill patients: measurement by 13 Coctanoic acid breath test. Crit Care Med 29:1744–1749 Ritz MA, Fraser R, Tam W, et al (2000) Impacts and patterns of disturbed gastrointestinal function in critically ill patients. Am J Gastroenterol 95:3044–3052 Bosscha K, Nieuwenhuijs VB, Vos A, et al (1998) Gastrointestinal motility and gastric tube feeding in mechanically ventilated patients. Crit Care Med 26:1510–1517 Chapman MJ, Fraser RJ, Bryant LK, et al (2008) Gastric emptying and the organization of antro-duodenal pressures in the critically ill. Neurogastroenterol Motil 20:27–35 Dive A, Moulart M, Jonard P, et al (1994) Gastroduodenal motility in mechanically ventilated critically ill patients: a manometric study. Crit Care Med 22:441–447 Kolbel CB, Rippel K, Klar H, et al (2000) Esophageal motility disorders in critically ill patients: a 24-hour manometric study. Intensive Care Med 26:1421–1427 Landzinski J, Kiser TH, Fish DN, et al (2008) Gastric motility function in critically ill patients tolerant vs intolerant to gastric nutrition. JPEN J Parenter Enteral Nutr 32:45–50 McClave SA, DeMeo MT, DeLegge MH, et al (2002) North American Summit on Aspiration in the Critically Ill Patient: consensus statement. JPEN J Parenter Enteral Nutr 26:S80–S85 Schuster-Bruce M (2001) Gastric emptying in the critically ill. Crit Care Med 29:1293–1294 Desachy A, Clavel M, Vuagnat A, et al (2008) Initial efficacy and tolerability of early enteral nutrition with immediate or gradual introduction in intubated patients. Intensive Care Med 34:1054–1059 Metheny N (1993) Minimizing respiratory complications of nasoenteric tube feedings: state of the science. Heart Lung 22:213–223 Metheny NA (2006) Preventing respiratory complications of tube feedings: evidence-based practice. Am J Crit Care 15:360–369 Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903 Cook D, Jonghe BD, Heyland D (1997) The relation between nutrition and nosocomial pneumonia: randomized trials in critically ill patients. Crit Care 1:3–9 Cook DJ, Kollef MH. (1998) Risk factors for ICU-acquired pneumonia. JAMA 279:1605–1606 Cook DJ, Meade MO, Hand LE, et al (2002) Toward understanding evidence uptake: semirecumbency for pneumonia prevention. Crit Care Med 30:1472–1477 Dodek P, Keenan S, Cook D, et al (2004) Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 141:305–313 Kollef MH. (2004) Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Crit Care Med 32:1396–1405 Montejo JC, Minambres E, Bordeje L, et al (2010) Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive care medicine 36:1386–1393 McClave SA, Lukan JK, Stefater JA, et al (2005) Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med 33:324–330 Reignier J, Dimet J, Martin-Lefevre L, et al (2009) Before-after study of a standardized ICU protocol for early enteral feeding in patients turned in the prone position. Clin Nutr 29:210–216 Reignier J, Mercier E, Le Gouge A, et al (2013) Effect of not monitoring residual gastric volume on risk of ventilatorassociated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA 309:249–256 Chapman MJ, Nguyen NQ, Fraser RJ. (2007) Gastrointestinal motility and prokinetics in the critically ill. Curr Opin Crit Care 13:187–194 Chapman MJ, Fraser RJ, Kluger MT, et al (2000) Erythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding. Crit Care Med 28:2334–2337 Reignier J, Bensaid S, Perrin-Gachadoat D, et al (2002) Erythromycin and early enteral nutrition in mechanically ventilated patients. Crit Care Med 30:1237–1241 Nguyen NQ, Chapman MJ, Fraser RJ, et al (2007) Erythromycin is more effective than metoclopramide in the treatment of feed intolerance in critical illness. Crit Care Med 35:483–489 Nguyen NQ, Chapman M, Fraser RJ, et al (2007) Prokinetic therapy for feed intolerance in critical illness: One drug or two? Crit Care Med 35:2561–2567 Nguyen NQ, Ng MP, Chapman M, et al (2007) The impact of admission diagnosis on gastric emptying in critically ill patients. Crit Care 11:R16 Reignier J, Thenoz-Jost N, Fiancette M, et al (2004) Early enteral nutrition in mechanically ventilated patients in the prone position. Crit Care Med 32:94–99 Leonet S, Fontaine C, Moraine JJ, et al (2002) Prone positioning in acute respiratory failure: survey of Belgian ICU nurses. Intensive Care Med 28:576–580 Davies AR, Froomes PR, French CJ, et al (2002) Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med 30:586–590 Marik P, Zaloga G (2003) Gastric versus post-pyloric feeding: a systematic review. Critical Care 7:R46–R51 Khalid I, Doshi P, DiGiovine B (2010) Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care 19:261–268 Doig GS, Simpson F, Finfer S, et al (2008) Effect of evidencebased feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial. JAMA 300:2731–2741 Mackenzie SL, Zygun DA, Whitmore BL, et al (2005) Implementation of a nutrition support protocol increases the proportion of mechanically ventilated patients reaching enteral nutrition targets in the adult intensive care unit. JPEN J Parenter Enteral Nutr 29:74–80 Heyland DK, Murch L, Cahill N, et al (2013) Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol in Critically Ill Patients: Results of a Cluster Randomized Trial. Crit Care Med 41:2743–2753