Adequate nutritional therapy in critically ill patients is integral to optimal outcome.Objective
To evaluate the association between cumulative macronutrient deficit and overall morbidity in surgical intensive care unit patients.Methods
Adult patients receiving enteral nutrition for more than 72 hours were included if they had no previous admission to the surgical intensive care unit, had received no enteral feedings before admission, had no intestinal obstruction or ileus, and survived 72 hours or more after admission. Data on demographics, outcomes, and nutritional intake during the unit stay were collected for up to 14 days until oral intake began, discharge, or death. Outcome variables included lengths of stay in the hospital and intensive care unit, days with no mechanical ventilation, complications, and mortality.Results
Of 94 participants, 71% were men, mean age was 63 years, and mean score on the Acute Physiology and Chronic Health Evaluation II was 14. Patients with high cumulative calorie deficit (≥ 6000 cal) and high protein deficit (≥ 300 g) had significantly fewer days with no mechanical ventilation (P < .001), longer unit stays (P < .001), longer hospital stays (P = .007), more total complications (P = .007), and more infectious complications (P = .009) than other participants. These associations remained significant in multivariable models after adjustments for age, sex, reason for admission, and propensity score of deficit. In-hospital and 30-day mortality did not differ.Conclusions
Cumulative macronutrient deficits have important clinical outcomes in surgical intensive care patients.
Provision of adequate nutrition during critical illness is thought to be integral to achieving optimal health outcomes.1-3 Providing timely, sufficient calories and protein is thought to influence both short-term outcomes (eg, intensive care unit [ICU] length of stay, ICU-acquired infections, duration of mechanical ventilation) and long-term outcomes (eg, hospital length of stay, discharge disposition). Observational studies2,4 and randomized trials have indicated an inverse relationship between daily calories received and complication rates. In a large international observational study across 167 ICUs, Alberda et al2 found a stepwise decrease in mortality associated with each additional 1000 cal provided per day in underweight and overweight patients. Dvir et al4 also found a strong correlation between increases in energy deficit and increases in complications such as renal failure and sepsis. Accordingly, consensus statements5-7 from professional nutrition societies emphasize initiating enteral nutrition within 24 to 48 hours of ICU admission. Yet, despite strong recommendations and compelling supportive evidence, ICU patients receive only about one-half of prescribed nutrition in the first 2 weeks of critical illness.2,8