| Abstract |
Background: In recent years the reports documenting the benefits of nutrition coverage of the critically ill patientsorpossible complications from its lack, such as muscle weakness, mechanical ventilation weaning failure, increasedlength of ICU stay, increased incidence of infections, morbidity and mortality,are increasing. The nutritional support of the critically ill patients in ICU begins with theassessment of nutritional status and the severity of the disease.During the acute phase, the nutritional goal is to ensure the organic well-functioning and the maintaining of muscle mass, in order to avoid energy and protein deficiencies, which have been associated with poor outcome. The nutrition support of the patientsis distinguishedin enteral and parenteral nutrition. The energy needs of the critically ill ideally is calculated based on indirect calorimetry, a method that is not available in most centers. For this reason, the calculation of nutritional support in ICU is based on energy prediction needs equation and specific recommendations from ASPEN/ESPEN. However, the existing equations do not correspond to the real energy requirements due to the unexpected change of their basal metabolism.Inaccurate estimation of energy needsmight lead to eitherunderfeedingoroverfeeding, conditions that adversely affect the patient’s outcome.
Objective: Τhe main purpose of this study is to study the nutritional support of critically ill adult patients who are treated in Intensive Care Unit (ICU)of the University Hospital of Heraklion (PAGNI) and to identifypossible associationsbetween nutritional needs and outcome indicators.Other objectives areto identify the groups of patients who are at greater nutritional risk for morbidity and adverse outcome. In addition, to study if there is a difference between nutritional coverage of patients and the recommended amounts of calories and proteins according to international guidelines. Methods: This is a retrospective analysis of consecutive patients admitted to ICU PAGNI during an one year period (01/01- 31/12/2020). The data collection was performed using electronic patient file of the Critis information system. The inclusioncriterionwasICUhospitalizationfor more than 4 days in the aforementioned period. At the end of the treatment, the nutritional coverage (proteins, carbohydrates and lipids) was recorded, the caloric (Harris Benedict) and protein (ESPEN recommendations) needs were calculated, and the correlation of these data with the outcome was examined. Results:The study included 235 patients with a median age of 70 years (IQR 56-78), duration of ICUhospitalization 13 days ( IQR 8-22), APACHE II 21.6 ± 6.9, mechanical ventilation80.4%, mNutric Score 3 ( IQR 2-4) and crude mortality of 21.7%. Patients normally started enteral feeding between the 3rd or 4th day of hospitalization with an average feeding duration of 9 days and a daily feeding interruption duration of 1 hour. The high percentage of nutritional support was covered by enteral feeding either alone or in combination with parenteral support. The use of parenteral alone or in combination with enteral feeding was significantly more common in patients who died compared to those who survived (p <0.05). The daily caloric intake, including glucose, protein, carbohydrate and lipid solutions showed a significant exponential increase between days 1 and 3and 7 (p <0.001). Among clinical parameters, only the total days of feeding(r = 0.23, p = 0.001) and hospitalization (r = 0.20, p = 0.005) were positively associated with a better daily nutritional support of the patients. Compared to the predicted basal metabolic rate and (BMR) and daily energy intake (BMI), patient’s calorie intake was negative on days 1,3 and 7 (p<0.001). A negative balance of ESPEN recommended daily protein intake was recorded on days 1,3 and 7(p<0.001), with a statistically significant difference between patients who survived and those who died. In ROC analysis, only adequate caloricintake (AUROC 0.95 (0.92-1.0), p <0.001) and the tape of nutritional support (proportionally increased use of parenteral nutrition (AUROC 0.81 (0.72-)) 0.9), p <0.001), could predict a positive balance of BMR- recommended calorie intake on day 7.
Conclusion: In the present study, daily caloric intake including glucose, protein, carbohydrate and lipid solution showed a significant exponential increase within the first 7 days of hospitalization. Nevertheless, the caloric and protein intake of patients differ (negative balance)from those recommended according to the guidelines. The comparison intake – recommended calories and proteins balance between the surviving patients and those who did not survive showed a greater negative balance in the group of patients who survived.
|
Search
