Daren K Heyland1, Rupinder Dhaliwal2, Miao Wang2, Andrew G Day3. 1. Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada; Department of Community Health and Epidemiology, Queen's University, Kingston, ON, Canada; Department of Medicine, Queen's University, Kingston, ON, Canada. Electronic address: dkh2@queensu.ca. 2. Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. 3. Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada; Department of Community Health and Epidemiology, Queen's University, Kingston, ON, Canada.
Abstract
BACKGROUND & AIMS: Adverse consequences may be experienced by critically ill patients who are underfed during their stay in the intensive care unit. The objective of this study is to determine the prevalence of iatrogenic underfeeding (receiving <80% of prescribed energy requirements) and the variation of these rates in different geographic regions of the world and in different nutritionally 'at-risk' patient populations. METHODS: This was a prospective, multi-institutional study in 201 units from 26 countries. We included 3390 mechanically ventilated patients who remained in the unit and received artificial nutrition for at least 96 h. We report time to start of enteral nutrition and % nutrition received in various geographic regions of the world and we focus on subgroups of 'high risk' patients (those with >7 days of mechanical ventilation, body mass index of <25 or ≥35, and those with a Nutrition Risk In the Critically ill (NUTRIC) score of ≥5). We report rates of novel enteral nutrition delivery techniques and supplemental parenteral nutrition in these high risk patients. RESULTS: On average, enteral feedings were started 38.8 h (standard deviation: 39.6) after admission, patients received 61.2% of calories and 57.6% of protein prescribed, and 74.0% of patients failed to meet the quality metric of receiving at least 80% of energy targets. There were significant differences in nutrition outcomes across different geographic regions. There were no clinically important differences in nutrition outcomes or rates of iatrogenic underfeeding in patients in different BMI groups nor by NUTRIC score. Of all at-risk patients, 14% were ever prescribed volume-based feeds, and 15% of patients ever received supplemental parenteral nutrition. CONCLUSIONS: Worldwide, the majority of critically ill patients, including high nutritional risk patients, fail to receive adequate nutritional intake. There is low uptake of strategies designed to optimize nutrition delivery in these patients.
BACKGROUND & AIMS: Adverse consequences may be experienced by critically illpatients who are underfed during their stay in the intensive care unit. The objective of this study is to determine the prevalence of iatrogenic underfeeding (receiving <80% of prescribed energy requirements) and the variation of these rates in different geographic regions of the world and in different nutritionally 'at-risk' patient populations. METHODS: This was a prospective, multi-institutional study in 201 units from 26 countries. We included 3390 mechanically ventilated patients who remained in the unit and received artificial nutrition for at least 96 h. We report time to start of enteral nutrition and % nutrition received in various geographic regions of the world and we focus on subgroups of 'high risk' patients (those with >7 days of mechanical ventilation, body mass index of <25 or ≥35, and those with a Nutrition Risk In the Critically ill (NUTRIC) score of ≥5). We report rates of novel enteral nutrition delivery techniques and supplemental parenteral nutrition in these high risk patients. RESULTS: On average, enteral feedings were started 38.8 h (standard deviation: 39.6) after admission, patients received 61.2% of calories and 57.6% of protein prescribed, and 74.0% of patients failed to meet the quality metric of receiving at least 80% of energy targets. There were significant differences in nutrition outcomes across different geographic regions. There were no clinically important differences in nutrition outcomes or rates of iatrogenic underfeeding in patients in different BMI groups nor by NUTRIC score. Of all at-risk patients, 14% were ever prescribed volume-based feeds, and 15% of patients ever received supplemental parenteral nutrition. CONCLUSIONS: Worldwide, the majority of critically illpatients, including high nutritional risk patients, fail to receive adequate nutritional intake. There is low uptake of strategies designed to optimize nutrition delivery in these patients.
Authors: Wolfgang H Hartl; Michael Hiesmayr; Martin Matejovic; Olivier Huet; Karolien Dams; Gunnar Elke; Clara Vaquerizo Alonso; Akos Csomos; Łukasz J Krzych; Romano Tetamo; Zudin Puthucheary; Olav Rooyackers; Inga Tjäder; Helmut Kuechenhoff Journal: Crit Care Date: 2022-05-18 Impact factor: 19.334
Authors: J M Raurich; J A Llompart-Pou; A García-de-Lorenzo; A Buño Soto; P Marsé; G Frontera; J Pérez-Bárcena Journal: Eur J Trauma Emerg Surg Date: 2017-10-04 Impact factor: 3.693