CCM:机械通气患者腹泻：一项嵌套的多中心亚研究

Abstract

Objective: 

The aim of this study was to examine the prevalence and incidence of diarrhea, diarrhea risk factors, processes of care, and clinical outcomes associated with diarrhea in invasively ventilated patients in the ICU.本研究旨在调查重症监护病房（ICU）中有创通气患者腹泻的患病率和发生率、腹泻的危险因素、护理过程以及与腹泻相关的临床结局

Design: 

Bedside nurses prospectively documented each patient’s bowel movement (BM) using the Bristol Stool Chart type and number. Research Coordinators collected baseline and daily data evaluating risk factors for diarrhea and patient outcomes. The diarrhea definition was the World Health Organization definition of ≥3 loose or watery BMs (Bristol type 6 or 7) per day. We used Cox proportional hazards regression to evaluate risk factors and the association with the risk of death in the ICU.床旁护士使用布里斯托大便分类法记录每位患者的排便（BM）类型和次数。研究协调员收集评估腹泻危险因素和患者结局的基线及每日数据。腹泻的定义采用世界卫生组织的标准，即每天≥3次稀便或水样便（布里斯托类型6或7）。我们使用Cox比例风险回归模型评估危险因素及其与ICU死亡风险的相关性

Setting: 

Forty-four ICUs in Canada, the United States, and Saudi Arabia.加拿大、美国和沙特阿拉伯的44个ICU

Patients: 

All 2,650 invasively ventilated critically ill patients were enrolled in this preplanned secondary analysis of a randomized trial that evaluated the probiotic Lactobacillus rhamnosus GG on infectious outcomes.本研究为预先计划的随机试验二次分析，纳入了2650名接受益生菌鼠李糖乳杆菌GG干预以评估其对感染性结局影响的接受有创通气的危重症患者

Interventions: 

None.无

Measurements and Main Results: 

Among 2,650 patients, the mean age (sd) was 59.8 (16.5) years, with an Acute Physiology and Chronic Health Evaluation II Score of 22.0 (7.8); 61.2% received inotropes/vasopressors on study day 1. Diarrhea occurred among 60.4% of patients and on 18.2% of ICU study days. Independent risk factors for diarrhea were a history of Clostridioides difficile infection, laxatives, and antibiotic use. Adjusted for these factors, enteral nutrition, particularly with moderate–high-protein content, also increased the risk of diarrhea. Univariable analysis suggested that diarrhea was associated with C. difficile testing, fecal management device insertion, and increased length of ICU and hospital stay. After adjusting for illness severity, mechanical ventilation, inotropes/vasopressors, renal replacement therapy, and severe infections, diarrhea was not associated with an increased risk of death.在2650名患者中，平均年龄（标准差）为59.8（16.5）岁，急性生理学与慢性健康评估II评分为22.0（7.8）；61.2%的患者在研究第1天使用了正性肌力药/血管加压药。60.4%的患者发生腹泻，占ICU研究日的18.2%。腹泻的独立危险因素包括艰难梭菌感染史、使用泻药和抗生素。在校正这些因素后，肠内营养，特别是中高蛋白含量的肠内营养也增加了腹泻的风险。单变量分析表明，腹泻与艰难梭菌检测、粪便管理装置置入以及ICU和住院时间延长相关。在校正疾病严重程度、机械通气、正性肌力药/血管加压药、肾脏替代治疗和严重感染后，腹泻与死亡风险增加无关。

Conclusions: 

Diarrhea is common among invasively ventilated patients. Risk factors include a history of C. difficile, use of antibiotics, laxatives, and enteral nutrition, particularly moderate–high-protein composition feeds.有创通气患者中腹泻常见。危险因素包括艰难梭菌感染史、使用抗生素、泻药和肠内营养，特别是中高蛋白组成的肠内营养。