Miroslav P Peev1, D Dante Yeh2, Sadeq A Quraishi3, Polina Osler4, Yuchiao Chang5, Erin Gillis6, Caitlin E Albano6, Sharon Darak6, George C Velmahos1. 1. Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts Department of Surgery, Harvard Medical School, Boston, Massachusetts. 2. Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts Department of Surgery, Harvard Medical School, Boston, Massachusetts dyeh2@partners.org. 3. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts Department of Anesthesia, Harvard Medical School, Boston, Massachusetts. 4. Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. 5. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts Department of Medicine, Harvard Medical School, Boston, Massachusetts. 6. Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Malnutrition and underfeeding are major challenges in caring for critically ill patients. Our goal was to characterize interruptions in enteral nutrition (EN) delivery and their impact on caloric debt in the surgical intensive care unit (ICU). MATERIALS AND METHODS: We performed a prospective, observational study of adults admitted to surgical ICUs at a Boston teaching hospital (March-December 2012). We categorized EN interruptions as "unavoidable" vs "avoidable" and compared caloric deficit between patients with ≥1 EN interruption (group 1) vs those without interruptions (group 2). Multivariable logistic regression was used to investigate the association of EN interruption with the risk of underfeeding. Poisson regression was used to investigate the association of EN interruption with length of stay (LOS) and mortality. RESULTS: Ninety-four patients comprised the analytic cohort. Twenty-six percent of interruptions were deemed "avoidable." Group 1 (n = 64) had a significantly higher mean daily and cumulative caloric deficit vs group 2 (n = 30). Patients in group 1 were at a 3-fold increased risk of being underfed (adjusted odds ratio, 2.89; 95% confidence interval [CI], 1.03-8.11), had a 30% higher risk of prolonged ICU LOS (adjusted incident risk ratio [IRR], 1.27; 95% CI, 1.14-1.42), and had a 50% higher risk of prolonged hospital LOS (adjusted IRR, 1.53; 95% CI, 1.41-1.67) vs group 2. CONCLUSIONS: In our cohort of critically ill surgical patients, EN interruption was frequent, largely "unavoidable," and associated with undesirable outcomes. Future efforts to optimize nutrition in the surgical ICU may benefit from considering strategies that maximize nutrient delivery before and after clinically appropriate EN interruptions.
BACKGROUND:Malnutrition and underfeeding are major challenges in caring for critically ill patients. Our goal was to characterize interruptions in enteral nutrition (EN) delivery and their impact on caloric debt in the surgical intensive care unit (ICU). MATERIALS AND METHODS: We performed a prospective, observational study of adults admitted to surgical ICUs at a Boston teaching hospital (March-December 2012). We categorized EN interruptions as "unavoidable" vs "avoidable" and compared caloric deficit between patients with ≥1 EN interruption (group 1) vs those without interruptions (group 2). Multivariable logistic regression was used to investigate the association of EN interruption with the risk of underfeeding. Poisson regression was used to investigate the association of EN interruption with length of stay (LOS) and mortality. RESULTS: Ninety-four patients comprised the analytic cohort. Twenty-six percent of interruptions were deemed "avoidable." Group 1 (n = 64) had a significantly higher mean daily and cumulative caloric deficit vs group 2 (n = 30). Patients in group 1 were at a 3-fold increased risk of being underfed (adjusted odds ratio, 2.89; 95% confidence interval [CI], 1.03-8.11), had a 30% higher risk of prolonged ICU LOS (adjusted incident risk ratio [IRR], 1.27; 95% CI, 1.14-1.42), and had a 50% higher risk of prolonged hospital LOS (adjusted IRR, 1.53; 95% CI, 1.41-1.67) vs group 2. CONCLUSIONS: In our cohort of critically ill surgical patients, EN interruption was frequent, largely "unavoidable," and associated with undesirable outcomes. Future efforts to optimize nutrition in the surgical ICU may benefit from considering strategies that maximize nutrient delivery before and after clinically appropriate EN interruptions.
Authors: S A McClave; L K Sexton; D A Spain; J L Adams; N A Owens; M B Sullins; B S Blandford; H L Snider Journal: Crit Care Med Date: 1999-07 Impact factor: 7.598
Authors: D A Spain; S A McClave; L K Sexton; J L Adams; B S Blanford; M E Sullins; N A Owens; H L Snider Journal: JPEN J Parenter Enteral Nutr Date: 1999 Sep-Oct Impact factor: 4.016
Authors: Sara Wilson; Nagendra Y Madisi; Adel Bassily-Marcus; Anthony Manasia; John Oropello; Roopa Kohli-Seth Journal: World J Crit Care Med Date: 2016-08-04
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