Nutritional protocols improve energy supply and reduce nitrogen loss in critical illness

Efficient artificial nutrition (AN) in critically ill patients may be associated with reduced catabolism as well as reduced mortality from sepsis. To evaluate the present practice of AN at our medical ICU we documented nutritional indicators during time interval A (January–April 1997). At that time we introduced nutritional protocols during ward rounds to improve the efficiency of AN during B (May–July 1997) and C (August–October 1997). In 103 patients who required AN for at least 4 days we analysed estimated energy requirement (Ere), prescribed energy supply (Ep), real energy supply (Er), percent of real enteral energy supply (Eer), the prevalence of hyperglycemia (HG) as well as nitrogen loss/24 h (NL) and ICU mortality rate (MR).

Results

(not including period B):

We observed that (a) total and percentage of enteral calory intake could be improved, while (b) N₂-loss was reduced as was (c) prevalence of hyperglycemia. (d) Real energy supply remains lower than doctors' prescriptions.

Conclusions

Nutritonal protocols (I) improve total and enteral energy supply and thereby (II) reduce catabolism in critically ill patients. (Ill) The 'gap' between prescriptions and performance proves to be consistent and remains a challenge for continuous quality improvement. A potential effect on ICU survival needs to be verified by further optimization of AN in larger patient groups.

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