Article

Villet S, Chiolero RL, Bollmann MD, et al: Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients

Anesthésiologie, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland.
Clinical Nutrition (Impact Factor: 4.48). 08/2005; 24(4):502-9. DOI: 10.1016/j.clnu.2005.03.006
Source: PubMed

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.

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    • "In the present meta-analysis, we aimed to specifically elucidate potential benefits of STGs 273 emulsions vs. MCT/LCT physical mixtures on relevant metabolic parameters and clinical outcomes, 274 including length of hospital/ICU stay and complications, in surgical and critically ill patients.These findings imply that STGs are more favorable than physical MCT/LCT mixtures with regard to 306 nutritional efficacy in critically ill and/or surgical patients. Considering that nutritional deficits in 307 critical illness are prone to rapidly progress to malnutrition, eventually leading to increased 308 complication rates and adverse outcomes[40,2]this finding is of particular interest. The underlying 309 mechanisms for the improved protein economy with STG-based emulsions have not yet been fully 310 elucidated and have been mainly explained by the differences between MCT and LCT. "
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    ABSTRACT: New generations of parenteral lipid emulsions combine Long Chain Triglycerides (LCTs) with Medium Chain Triglycerides (MCTs) either by physically mixing MCT- and LCT-containing oils or by using synthetically structured triglycerides (STGs). In order to clarify some open issues relating to their comparative effect, in particular in terms of clinical outcomes, pertinent evidence was systematically identified, reviewed and meta-analyzed.
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    • "Adapting caloric intakes to REE has long been considered a minor issue in the first days of ICU hospitalization while energy deficit is now correlated with various complications [5,6]. Patients with major energy deficit are reported to have a longer ICU stay, prolonged mechanical ventilation and are more frequently exposed to nosocomial infections [3-8]. Because of its impact on ICU morbidity, early nutritional assessment might be a major challenge in order to prevent further complications and, therefore, reduce ICU mortality [9]. "
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    ABSTRACT: Estimation of body composition as fat-free mass (FFM) is subjected to many variations caused by injury and stress conditions in the intensive care unit (ICU). Body cell mass (BCM), the metabolically active part of FFM, is reported to be more specifically correlated to changes in nutritional status. Bedside estimation of BCM could help to provide more valuable markers of nutritional status and may promote understanding of metabolic consequences of energy deficit in the ICU patients. We aimed to quantify BCM, water compartments and FFM by methods usable at the bedside for evaluating the impact of sudden and massive fluid shifts on body composition in ICU patients. We conducted a prospective experimental study over a 6 month-period in a 18-bed ICU. Body composition of 31 consecutive hemodynamically stable patients requiring acute renal replacement therapy for fluid overload (ultrafiltration >=5% body weight) was investigated before and after the hemodialysis session. Intra-(ICW) and extracellular (ECW) water volumes were calculated from the raw values of the low- and high-frequency resistances measured by multi-frequency bioelectrical impedance. BCM was assessed by a calculated method recently developed for ICU patients. FFM was derived from BCM and ECW. Intradialytic weight loss was 3.8 +/- 0.8 kg. Percentage changes of ECW (-7.99 +/- 4.60%) and of ICW (-7.63 +/- 5.11%) were similar, resulting ECW/ICW ratio constant (1.26 +/- 0.20). The fall of FFM (-2.24 +/- 1.56 kg, -4.43 +/- 2.65%) was less pronounced than the decrease of ECW (P < 0.001) or ICW (P < 0.001). Intradialytic variation of BCM was clinically negligible (-0.38 +/- 0.93 kg, -1.56 +/- 3.94 %) and was significantly lesser than FFM (P < 0.001). BCM estimation is less driven by sudden massive fluid shifts than FMM. Assessment of BCM should be preferred to FFM when severe hydration disturbances are present in ICU patients.
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    • "Chez les patients pour lesquels les apports alimentaires oraux sont possibles, les compléments nutritionnels oraux (CNO) peuvent être utilisés bien qu'aucune étude n'en ait confirmé l'intérêt dans ce contexte. Le recours aux CNO ne doit pas faire retarder la mise en route d'une nutrition entérale chez les patients ne couvrant pas leurs besoins énergétiques [19]. Il ne faut probablement pas prescrire de CNO spécifiques. "

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