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Current Literature: Caloric Intake in Medical ICU Patients: Consistency of Care With Guidelines and Relationship to Clinical Outcomes
Author(s) -
Canada Todd
Publication year - 2004
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/0115426504019006645
Subject(s) - medicine , caloric theory , parenteral nutrition , intensive care unit , intensive care , mechanical ventilation , body mass index , prospective cohort study , sepsis , enteral administration , caloric intake , emergency medicine , intensive care medicine , obesity
Objectives: To assess the consistency of caloric intake with American College of Chest Physicians (ACCP) recommendations for critically ill patients and to evaluate the relationship of caloric intake with clinical outcomes. Design: Prospective cohort study. Setting: Adult intensive care units (ICUs) at 2 teaching hospitals. Participants: Patients with an ICU length of stay of at least 96 hours. Measurements and results: On ICU admission, severity of illness (ie, simplified acute physiology score II) and markers of nutritional status (ie, serum albumin level and body mass index) were recorded. The route of feeding (ie, enteral or parenteral), actual caloric intake (ie, percentage of ACCP recommendations: 0% to 32% [tertile I]; 33% to 65% [tertile II]; ≥66% [tertile III]), and evidence of GI intolerance (ie, gastric aspirate levels, ≥100 mL) were recorded daily. The following outcomes were assessed: status on hospital discharge (alive vs dead); spontaneous ventilation before ICU discharge (yes vs no); and ICU discharge without developing nosocomial sepsis (yes vs no). The average caloric intake among 187 participants was 50.6% of the ACCP targets and was similar in both hospitals. Caloric intake was inversely related to the mean number of gastric aspirates≥ 100 mL/d (Spearman ρ =–.04; p = .06), but not to severity of illness, nutritional status, or route of feeding. After accounting for the number of gastric aspirates ≥100 mL, severity of illness, nutritional status, and route of feeding, tertile II of caloric intake ( vs tertile I) was associated with a significantly greater likelihood of achieving spontaneous ventilation before ICU discharge. Tertile III of caloric intake ( vs tertile I) was associated with a significantly lower likelihood of both hospital discharge alive and spontaneous ventilation before ICU discharge. Conclusions: Study participants were underfed relative to ACCP targets. These targets, however, may overestimate needs because moderate caloric intake (ie, 33% to 65% of ACCP targets; approximately 9 to 18 kcal/kg per day) was associated with better outcomes than higher levels of caloric intake.