Alvaro A C Morais1, Joel Faintuch2, Eliana B Caser3, Daniel S Costa4, Bruno A Pazolini4, Ary C Oliveira5. 1. Nutritional Support Service, EMESCAM Medical School, Vitoria, ES, Brazil. Electronic address: alvarocmorais@yahoo.com.br. 2. Nutrology Residency Program, Hospital das Clinicas, Sao Paulo, SP, Brazil. 3. Intensive Care Unit, CIAS UNIMED Hospital, Vitoria, ES, Brazil. 4. EMESCAM Medical School, Vitoria, ES, Brazil. 5. CIAS UNIMED Hospital, Vitoria, ES, Brazil.
Abstract
BACKGROUND: Few investigations have correlated long-term nutritional support (NS) with outcome in the intensive care unit, in comparison with NS for shorter periods. OBJECTIVE: In a retrospective protocol, duration of enteral and/or parenteral nutrition was analyzed in the light of severity of illness, targeting hospital mortality. RESULTS: Seriously ill patients (n = 100), nearly all (94/100) receiving enteral nutrition (51/100), parenteral nutrition (22/100), or both (21/100), were investigated. Mean age ± SD was 60.0 ± 19.5 years (54.0% males), 56.0% were in the trauma or surgery diagnostic category, Mean Acute Physiologic and Chronic Health Evaluation II ± SD was 14.2 ± 6.7, mechanical ventilation was necessary in 41.0%, and hospital mortality was 14.0%. Nutritional support of any modality administered for 18 days or less (mean ± SD, 4.3 ± 3.6 days) was associated with favorable survival rate, whereas for longer periods (mean ± SD, 48.5 ± 29.4 days), mortality substantially increased (7.7% vs 50.0%, P = .004). Results were confirmed when long-term patients were propensity matched regarding age, Acute Physiologic and Chronic Health Evaluation II, Glasgow scale, and mechanical ventilation (6.3% vs 50.0%, P = 04). CONCLUSIONS: Nutritional support of more than 18 days was associated with higher mortality. This finding persisted after adjustment for major risk factors, in agreement with the hypothesis that prolonged impossibility of oral alimentation is a marker of mortality in the intensive care unit setting.
BACKGROUND: Few investigations have correlated long-term nutritional support (NS) with outcome in the intensive care unit, in comparison with NS for shorter periods. OBJECTIVE: In a retrospective protocol, duration of enteral and/or parenteral nutrition was analyzed in the light of severity of illness, targeting hospital mortality. RESULTS: Seriously ill patients (n = 100), nearly all (94/100) receiving enteral nutrition (51/100), parenteral nutrition (22/100), or both (21/100), were investigated. Mean age ± SD was 60.0 ± 19.5 years (54.0% males), 56.0% were in the trauma or surgery diagnostic category, Mean Acute Physiologic and Chronic Health Evaluation II ± SD was 14.2 ± 6.7, mechanical ventilation was necessary in 41.0%, and hospital mortality was 14.0%. Nutritional support of any modality administered for 18 days or less (mean ± SD, 4.3 ± 3.6 days) was associated with favorable survival rate, whereas for longer periods (mean ± SD, 48.5 ± 29.4 days), mortality substantially increased (7.7% vs 50.0%, P = .004). Results were confirmed when long-term patients were propensity matched regarding age, Acute Physiologic and Chronic Health Evaluation II, Glasgow scale, and mechanical ventilation (6.3% vs 50.0%, P = 04). CONCLUSIONS: Nutritional support of more than 18 days was associated with higher mortality. This finding persisted after adjustment for major risk factors, in agreement with the hypothesis that prolonged impossibility of oral alimentation is a marker of mortality in the intensive care unit setting.