Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients
ABSTRACT Critically ill patients with complicated evolution are frequently hypermetabolic, catabolic, and at risk of underfeeding. The study aimed at assessing the relationship between energy balance and outcome in critically ill patients.
Prospective observational study conducted in consecutive patients staying > or = 5 days in the surgical ICU of a University hospital. Demographic data, time to feeding, route, energy delivery, and outcome were recorded. Energy balance was calculated as energy delivery minus target. Data in means+/-SD, linear regressions between energy balance and outcome variables.
Forty eight patients aged 57+/-16 years were investigated; complete data are available in 669 days. Mechanical ventilation lasted 11+/-8 days, ICU stay 15+/-9 was days, and 30-days mortality was 38%. Time to feeding was 3.1+/-2.2 days. Enteral nutrition was the most frequent route with 433 days. Mean daily energy delivery was 1090+/-930 kcal. Combining enteral and parenteral nutrition achieved highest energy delivery. Cumulated energy balance was between -12,600+/-10,520 kcal, and correlated with complications (P < 0.001), already after 1 week.
Negative energy balances were correlated with increasing number of complications, particularly infections. Energy debt appears as a promising tool for nutritional follow-up, which should be further tested. Delaying initiation of nutritional support exposes the patients to energy deficits that cannot be compensated later on.
- SourceAvailable from: Noël J M CanoAnnales francaises d'anesthesie et de reanimation 02/2014; 28(2). DOI:10.1016/j.annfar.2014.01.008
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ABSTRACT: Numerous definitions of diarrhoea are found in the literature. The onset of at least three liquid or soft stools per day is the simplest and the most applicable definition for the daily clinical practice. Aetiologies of diarrhoea are multiple. The context is sometimes obvious: recent intestinal surgery (short bowel syndrome), digestive disease leading to malabsorption (e.g., Crohn's disease), or digestive infection (e.g., Clostridium difficile). Once these different aetiologies ruled out, drug intake (e.g., laxatives, antibiotics) or enteral nutrition (EN) can be suspected. EN constitutes the first choice of nutritional support when the gastrointestinal tract is functional. The onset of EN-associated diarrhoea should not be systematically considered as a non-functionality of the gastrointestinal tract, and should not lead to a systematic stop of EN. The management of EN-associated diarrhoea is mandatory, because of the several consequences of diarrhoea on the patient, the daily work of health care professionals, and finally, health-related costs. The maintaining of fluid and electrolytes balance is a priority. This article proposes a flow chart for the management of EN-associated diarrhoea. If EN is considered as the primary cause of diarrhoea, changes in the administration flow rate or replacement of the EN solution have to be considered. The best management of EN-associated diarrhoea is its prevention, based on the respect of EN initiation and administration rules.Nutrition Clinique et Métabolisme 02/2013; 27(1):51–53. DOI:10.1016/j.nupar.2012.11.005
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ABSTRACT: OBJECTIVE: Children admitted to the intensive care unit (ICU) are at risk of inadequate energy intake. Although studies have identified factors contributing to an inadequate energy supply in critically ill children, they did not take into consideration the length of time during which patients received their estimated energy requirements after having achieved a satisfactory energy intake. This study aimed to identify factors associated with the non-attainment of estimated energy requirements and consider the time this energy intake is maintained. METHODS: This was a prospective study involving 207 children hospitalized in the ICU who were receiving enteral and/or parenteral nutrition. The outcome variable studied was whether 90% of the estimated basal metabolic rate was maintained for at least half of the ICU stay (satisfactory energy intake). The exposure variables for outcome were gender, age, diagnosis, use of vasopressors, malnutrition, route of nutritional support, and Pediatric Index of Mortality and Pediatric Logistic Organ Dysfunction scores. RESULTS: Satisfactory energy intake was attained by 20.8% of the patients, within a mean time of 5.07 ± 2.48 d. In a multivariable analysis, a diagnosis of heart disease (odds ratio 3.62, 95% confidence interval 1.03-12.68, P = 0.045) increased the risk of insufficient energy intake, whereas malnutrition (odds ratio 0.43, 95% confidence interval 0.20-0.92, P = 0.030) and the use of parenteral nutrition (odds ratio 0.34, 95% confidence interval 0.15-0.77, P = 0.001) were protective factors against this outcome. CONCLUSION: A satisfactory energy intake was reached by a small proportion of patients during their ICU stay. Heart disease was an independent risk factor for the non-attainment of satisfactory energy intake, whereas malnutrition and the use of parenteral nutrition were protective factors against this outcome.Nutrition 08/2012; 29(1). DOI:10.1016/j.nut.2012.04.003