Inadequate energy and protein and associate factors in critically ill patients
Keywords:
Critical care, Energy intake, Energy requirement, Enteral nutrition, Nutrition therapyAbstract
Objective
To investigate the energy and protein adequacies of intensive care unit of a university hospital patients in exclusive enteral nutrition.
Methods
This longitudinal study was conducted between April and November 2014 in the adult intensive care unit of a university hospital. The following items were assessed during 14 days: percentage of protein energy adequacy, based on the mean prescribed and administered values; clinical conditions (unit and diagnosis on admission, Acute Physiology and Chronic Health Evaluation II, nutritional status, and length of stay); gastrointestinal complications; and reason for diet interruption. Values below 80% of the caloric and protein adequacies were considered inadequate. Multivariate analysis was performed by Poisson Regression at a significance level of 5%.
Results
The sample consisted of 38 patients, and 52.63% were undernourished. The mean caloric and protein adequacies were 76.47% and 69.11%, respectively. The prevalences of caloric and protein inadequacies were 55.26% and 68.42%, respectively. Fasting for procedures was the most frequent cause for diet interruption. Residual gastric volume and diarrhea were the most common gastrointestinal complications. Caloric inadequacy was associated with length of stay ≤14 days and high residual gastric volume. Protein inadequacy was associated with length of stay ≤14 days, high residual gastric volume, and catheter displacement or obstruction.
Conclusion
More than half of the patients had caloric and protein inadequacies. Strategies, such as the development of protocols for multidisciplinary teams, should be created to minimize disruption of the administered diet, establish measures to control gastrointestinal complications, and thus ensure adequate nutritional intake during intensive care unit stay.
References
Jensen GL, Wheeler D. A new approach to defining and diagnosing malnutrition in adult critical illness. Curr Opin Crit Care. 2012; 18(2):206-11. http:// dx.doi.org/10.1097/MCC.0b013e328351683a
Projeto Diretrizes. Terapia Nutricional no Paciente Grave. São Paulo: Sociedade Brasileira de Nutrição Enteral e Parenteral; 2011 [acesso 2016 mar 10]. Disponível em: http://www.projetodiretrizes.org.br/ 9_volume/terapia_nutricional_no_paciente_ grave.pdf
Ribeiro LMK, Oliveira Filho RS, Caruso L, Lima PA, Damasceno NRT, Soriano FG. Adequação dos ba lanços energético e proteico na nutrição por via enteral em terapia intensiva: quais são os fatores limitantes? Rev Bras Ter Intensiva. 2014; 26(2):155-62. http://dx.doi.org/10.5935/0103-507X.20140023
Hegazi RA, Wischmeyer PE. Clinical review: Optimizing enteral nutrition for critically ill patients - a simple data-driven formula. Crit Care. 2011; 15(6):1385-8. http://dx.doi.org/10.1186/cc10430
Kreymann KG, Berger MM, Deutzc NEP, Hiesmayrd M, Jolliete P, Kazandjiev G, et al. ESPEN guidelines on enteral nutrition: Intensive care. Clin Nutr. 2006; 25(2):210-23. http://dx.doi.org/10.1016/j.clnu. 2006.01.021
Doig GS, Simpson F, Sweetman EA, Finfer SR, Cooper DJ, Heighes PT, et al. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: A randomized controlled trial. JAMA. 2013; 309(20):2130-8. http://dx.doi.org/10.1001/jama. 2013.5124
American Society for Parenteral and Enteral Nutrition. Guidelines for the provision and assessment of nutritional support therapy in the adult critically ill patients. J Parenter Enteral Nutr. 2009; 33(3):277-316. http://dx.doi.org/10.1177/ 0148607109335234
Oliveira SM, Burgos MGPA, Santos EMC, Prado LVS, Petribu MMV, Bonfim FMTS. Complicações gastrintestinais e adequação calórico-proteica de pacientes em uso de nutrição enteral em uma unidade de terapia intensiva. Rev Bras Ter Intensiva. 2010; 22(3):270-3. http://dx.doi.org/10.1590/S0 103-507X2010000300009
Agudelo GM, Giraldo NA, Román J, Serna A, Hoyos M, Aguilar N, et al. Incidencia de complicaciones del soporte nutricional en pacientes críticos: Estudio multicêntrico. Nutr Hosp. 2011; 26(5):537-45.
Sant’ana IES, Mendonça SS, Marshall, NG. Ade quação energético-proteica e fatores determinantes na oferta adequada de nutrição enteral em pa cientes críticos. Com Ciên Saúde. 2013; 22(4):47-56.
Heidegger CP, Darmon P, Pichard C. Enteral VS. Parenteral nutrition for the critically ill patient: A combined support should be preferred. Curr Opin Crit Care. 2008; 14(4):408-14. http://dx.doi.org/ 10.1097/MCC.0b013e3283052cdd
Oliveira-Filho RS, Tamburrino AC, Trevisani VS, Rosa VM. Main barriers in control of energy-protein deficit in critical oncologic patient at nutritional risk. J Integr Oncol. 2016; 5(1):156. http://dx.doi.org/ 10.4172/2329-6771.1000156
Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux RNMC, Delarue J, et al. Negative impact of hypocaloric feeding and energy balance on clinicaloutcome in ICU patients. Clin Nutr. 2005; 25(4):502-9. http://dx.doi.org/10.1016/j.clnu. 2005.03.006
Seron-Arbeloa C, Zamora-Elson M, Labarta Monzon L, Mallor-Bonet T. Enteral nutrition in critical care. J Clin Med Res. 2013; 5(1):1-11. http://dx. doi.org/10.4021/jocmr1210w
Thibault R, Pichard C. Nutrition and clinical outcome in intensive care patients. Curr Opin Clin Nutr Metab Care. 2010; 12(2):177-83. http://dx.doi.org/ 10.1097/MCO.0b013e32833574b9
Aranjues AL, Teixeira ACC, Caruso L, Soriano FG. Monitoração da terapia nutricional enteral em UTI: indicador de qualidade? Mundo da Saúde. 2008; 32(1):16-23.
Oliveira NS, Caruso L, Bergamaschi DP, Cartolano FC, Soriano FG. Impacto da adequação da oferta energética sobre a mortalidade em pacientes de UTI recebendo nutrição enteral. Rev Bras Ter Inten siva. 2011; 23(2):183-9. http://dx.doi.org/10.1590/S0 103-507X2011000200011
Boullata J, Carney LN, Guenter P. Enteral nutrition handbook. 2ª ed. Silver Spring: Aspen; 2010.
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr. 1987; 11(1):8-13.
Chumlea WC, Guo SS, Roche AF, Steinbaugh ML. Prediction of body weight for the nonambulatory elderly from anthropometry. J Am Diet Assoc. 1988; 88(5):563-8.
Couto CFL, Moreira JS, Hoher JA. Terapia nutricional enteral em politraumatizados sob ventilação me cânica e oferta energética. Rev Nutr. 2012; 25(6):695-705. http://dx.doi.org/10.1590/S1415-5 2732012000600002
Assis MCS, Silva SMR, Leaes DM, Novello CL, Silveira CRM, Mello ED, et al. Nutrição enteral: diferenças entre volume, calorias e proteínas prescritos e admi nistrados em adultos. Rev Bras Ter Intensiva. 2010; 22(4):346-50. http://dx.doi.org/10.1590/S01035 07X2010000400006
O’Meara D, Mireles-Cabodevila E, Frame F, Hummell AC, Hammel J, Dweik RA, et al. Evaluation of delivery of enteral nutrition in critically ill patients receiving mechanical ventilation. Am J Crit Care. 2008; 17(1):53-61.
Campanella LCA, Silveira BM, Rosário Neto O, Silva AA. Terapia nutricional enteral: a dieta prescrita é realmente infundida? Rev Bras Nutr Clin. 2008; 23(1):21-5.
Teixeira ACC, Caruso L, Soriano F. Terapia nutri cional enteral em unidade de terapia intensiva: infusão versus necessidades. Rev Bras Ter Intensiva. 2006; 18(4):331-7.
Campos DJ, Silva AFF, Souza MH, Shieferdecker ME. Otimização do fornecimento calórico-proteico na terapia de nutrição enteral em unidade de terapia intensiva com o uso de protocolo. Rev Bras Nutr Clin. 2006; 21(1):2-5
Isidro MF, Lima DSC. Adequação calórico-proteica da terapia nutricional enteral em pacientes cirúr gicos. Rev Assoc Med Bras. 2012; 58(5):580-6. http://dx.doi.org/10.1590/S0104-4230201200 0500016
Oliveira NS, Caruso L, Soriano FG. Terapia nutri cional enteral em UTI: seguimento longitudinal. Nutrire: Rev Soc Bras Alim Nutr. 2010; 35(3):133-48.
McClave AS, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the provision and assessment of nutrition support in the adult critically ill patient: Society of critical care medicine (SCCM) and american society for parenteral and enteral nutrition (ASPEN). J Parenter Enteral Nutr. 2016;40(2):159-211. http://dx. doi.org/10.1177/0148607109335234
Fernández Ortega JF, Meseguer JH, García PM. Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Indications, timing and routes of nutrient delivery. Nutr Hosp. 2011; 26(Suppl. 2):7-11. http://dx.doi.org/10.1590/S0 212-16112011000800009
Heyland DK, Cahill NE, Dhaliwal R, Wang M, Day AG, Alenzi A, et al. Enhanced protein-energy provision via the enteral route in critically ill patients: A single center feasibility trial of the PEP uP protocol. Crit Care. 2010; 14(2):R78. http://dx.doi.org/10. 1186/cc8991
Borges RM, Nonino-Borges CB, Campos AD, Basile- -Filho A. Incidência de complicações em terapia nutricional enteral de pacientes em estado grave. Rev Bras Ter Intensiva. 2005;17(2):98-103.
Agudelo GM, Giraldo NA, Román J, Serna A, Hoyos M, Aguilar N, et al. Incidencia de complicaciones del soporte nutricional en pacientes críticos: estudio multicêntrico. Nutr Hosp. 2011; 26(5):537-45. http:// dx.doi.org/10.3305/nh.2011.26.3.4789
Cahill NE, Dhaliwal R, Day AG, Jiang X, Heyland D. Nutrition therapy in the critical care setting: What is “best achievable” practice? An international multicenter observational study. Crit Care Med. 2010; 38(2):395-401. http://dx.doi.org /10.1097/ CCM.0b013e3181c0263d
Krishnan JA, Parce PB, Martinez A, Diette GB, Brower RG. Caloric intake in medical ICU Patients. Chest. 2003;124(1):297-305.
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