How long does it takes to begin nutrition support in the ICU?

Introduction

Nutritional support is very important in critically ill patients and many studies have been performed trying to optimize the nutritional therapy and to minimize the muscular catabolism of this group of patients.

Objective

The present study demonstrated how long it takes to begin and to complete nutritional support in critically ill patients in the ICU, compared with clinical and surgical patients, and analyzed the complications and the causes of discontinuation of nutritional support in the ICU.

Materials and methods

A prospective analysis of 85 patients (32 women and 53 men), 68 clinical and 17 surgical diagnoses, admitted to a 41-bed ICU from July 2004 to February 2005. The present study analyzed the time to begin and to complete nutritional support, the reason for discontinuation, the complications and the position of the catheter to provide the nutritional support.

Results

The patient APACHE II score was 16.6 and 17 for surgical and clinical patients, respectively. The time to begin nutrition support was 3.52 and 2.1 days for surgical and clinical patients, respectively. The clinical patients had a gastric catheter in 51 patients and a catheter in the jejune position in 17 patients. The diet used was polymeric in 60 patients and oligomeric in eight patients; discontinuation of nutrition occurred in nine cases (13.4%) (four mesenteric ischemia, three hemodynamic instability, one oral nutrition and one gastrointestinal hemorrhage), and diarrhea occurred in 20 patients (29.41%), but it was auto limited and the average was 1.61 episodes/day. Gastroparesis occurred in 14 patients (20.6%) but all of them except one resolved in 1 day without needing a change of the catheter position and without relation to the catheter position. Eighteen patients died (26.47%). The surgical patients had a gastric catheter in 10 patients and a catheter in the jejune position in seven patients; discontinuation of nutrition occurred in three cases (17.64%) (two mesenteric ischemia, one hemodynamic instability), and diarrhea occurred in eight patients (47%), but it was auto limited and the average was 3.05 episodes/day. Gastroparesis occurred in four patients (23.5%) but all of them resolved in 1 day without needing to change the catheter position; all of them were related to hemodynamic instability. Four patients died (23.5%).

Conclusion

The time to beginning nutrition support was shorter in the clinical group compared with the surgical group in spite of complete nutritional support in surgical patients being shorter. We did not observe too many complications and the majority received the nutritional support proposed. Diarrhea was more prevalent in the surgical group but was not involved in discontinuation of nutrition. The mortality was similar in both groups.