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Hypocaloric nutrition and outcome in critically ill patients with prolonged ICU stay

Introduction

While implementation of protocols for nutritional support is associated with less energy deficit [1, 2], the impact of hypocaloric feeding on clinical relevant outcomes is more controversial: recent studies suggested both positive [3, 4] and negative effects [5] in patients receiving the recommended intakes. The aim of this study was to assess the incidence and magnitude of hypocaloric feeding in an ICU without explicit nutrition protocols together with standardized mortality ratios.

Methods

A retrospective analysis of data from all patients staying >72 hours in a mixed medical–surgical 30-bed university hospital ICU in 2006.

Results

Data from 562 patients (medical 270 patients, surgical 292 patients) were analyzed. The lengths of ICU and hospital stay were 9 ± 9 days and 27 ± 25 days. The age was 61 ± 16 years, weight 77 ± 17 kg, BMI 26 ± 5 kg/m2, and APACHE II and SAPS scores 24 ± 8 and 50 ± 17. Daily energy and protein intake were 302 ± 33 kcal and 12 ± 1 g (recommended amount of energy and protein intake according to the European Society of Parenteral and Enteral Nutrition: 1,549 ± 34 kcal and 114 ± 2 g). Patients were mechanically ventilated during 7 ± 8 days. ICU mortality was 14% (expected by APACHE II and SAPS II: 50% and 46%), and hospital mortality was 22%. The total caloric deficit per patient was 9,820 ± 1,126 kcal. The distribution of the acquired energy deficit was: 0–5,000 kcal (20%), 5,000–7,500 kcal (31%), 7,500–10,000 kcal (20%), 10,000–20,000 kcal (22%), 20,000–30,000 kcal (4%), >30,000 kcal (3%).

Conclusion

Most patients with an ICU stay >72 hours acquired a substantial caloric deficit during the study period when compared with recommendations. Despite this, mortality was relatively low for the measured APACHE II and SAPS II scores. Nutrition protocols should be used and their impact on both the delivered calories and clinically relevant outcome parameters be monitored.

References

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Iff, S., Leuenberger, M., Stanga, Z. et al. Hypocaloric nutrition and outcome in critically ill patients with prolonged ICU stay. Crit Care 12, P141 (2008). https://doi.org/10.1186/cc6362

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Keywords

  • Standardize Mortality Ratio
  • Energy Deficit
  • Caloric Deficit
  • Clinical Relevant Outcome
  • Recommended Amount