Abstract
Patients requiring mechanical ventilation in an intensive care unit commonly fail
to attain enteral nutrition (EN) infusion goals. We conducted a cohort study to quantify
and compare the percentage of energy and protein received between standard care (n=24)
and intensive medical nutrition therapy (MNT) (n=25) participants; to assess the percentage
of energy and protein received varied by nutritional status, and to identify barriers
to EN provision. Intensive MNT entailed providing energy at 150% of estimated needs,
using only 2.0 kcal/cc enteral formula and 24-hour infusions. Estimated energy and
protein needs were calculated using 30 kcal/kg and 1.2 g protein/kg actual or obesity-adjusted
admission body weight. Subjective global assessment was completed to ascertain admission
intensive care unit nutritional status. Descriptive statistics and survival analyses
were conducted to examine time until attaining 100% of feeding targets. Patients had
similar estimated energy and protein needs, and 51% were admitted with both respiratory
failure and classified as normally nourished (n=25/49). Intensive MNT recipients achieved
a greater percentage of daily estimated energy and protein needs than standard care
recipients (1,198±493 vs 475±480 kcal, respectively, P<0.0001; and 53±25 vs 29±32 g, respectively, P=0.007) despite longer intensive care unit stays. Cox proportional hazards models
showed that intensive MNT patients were 6.5 (95% confidence interval 2.1 to 29.0)
and 3.6 (95% confidence interval 1.2 to 15.9) times more likely to achieve 100% of
estimated energy and protein needs, respectively, controlling for confounders. Malnourished
patients (n=13) received significantly less energy (P=0.003) and protein (P=0.004) compared with normally nourished (n=11) patients receiving standard care.
Nutritional status did not affect feeding intakes in the intensive MNT group. Clinical
management, lack of physician orders, and gastrointestinal issues involving ileus,
gastrointestinal hemorrhage, and EN delivery were the most frequent clinical impediments
to EN provision. It was concluded that intensive MNT could achieve higher volumes
of EN infusion, regardless of nutritional status. Future studies are needed to advance
this methodology and to assess its influence on outcomes.
Keywords
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Biography
P. M. Sheean is a post-doctoral research associate, University of Illinois at Chicago Institute for Health Policy and Research, Chicago.
Biography
S. J. Peterson is a clinical dietitian, Department of Food and Nutrition, Rush University Medical Center, Chicago, IL.
Biography
D. P. Gurka is chief and director of critical care medicine, Rush University Medical Center, Chicago, IL.
Biography
W. Zhao is a research assistant, Department of Epidemiology and Biostatistics, University of Illinois at Chicago.
Biography
C. A. Braunschweig is a professor, Department of Kinesiology and Nutrition, University of Illinois at Chicago.
Article info
Publication history
Published online: May 12, 2012
Accepted:
February 3,
2012
Available online 12 May 2012Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT Support for this study was provided by the National Institutes of Health, National Heart, Lung, and Blood Institute, grant no. R01 HL093142-02, and the National Cancer Institute, Cancer Education and Career Development Program, grant no. R25CA057699-18.
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© 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
