Abstract
Background
In critically-ill patients requiring mechanical ventilation for longer than 48-72 hours enteral nutrition (EN) should be started early. Since EN alone may be unable to reach the target nutritional requirement, supplemental parenteral nutrition should be administered. This study aimed at describing the daily rate of administered calories and proteins according to the expected calculated targets. The impact of calorie adequacy, deficit or excess on relevant clinical outcomes was explored.
Methods
Retrospective cohort study in 217 cardiac-surgery patients admitted postoperatively in intensive care unit (ICU) and undergoing EN. The effective intake provided via EN, parenteral nutrition (PN), oral nutritional supplements (ONS) and non-nutritional calories (NNC) was documented for a maximum of 20 days. The administered/required calories and proteins ratios (KcalA/R, ProtA/R) were calculated daily. Patients receiving 80-100%, < 80 % or > 100% of KcalA/R and ProtA/R were identified. The association between mean KcalA/R between day 4-7 and 30-days mortality was explored.
Results
A mean KcalA/R ratio of 92.0±40.6% was ensured between days 4-20. During days 4-7 the 80-100% calorie target was achieved in 26.9% of patients, while 44.9% were below and 28.2% over this range. EN contributed for 47.1% and PN for 41.2% to the total energy intake. An increase in 30-days mortality risk was documented for patients exceeding 100% of KcalA/R ratio (adjusted-HR 5.2; 95% CI 1.1-23.9; p=0.035).
Conclusions
Despite a preliminary estimate of nutritional requirement, a steady daily optimal 80-100% KcalA/R was not ensured to all patients. EN contributed only partially to both energy and protein intakes so that PN was largely used to achieve the desired nutritional targets.
This a rticle is protected by copyright. All rights reserved.
No comments:
Post a Comment