Meeting Calorie and Protein Needs in the Critical Care Unit: A Prospective Observational Pilot Study

Abstract

Background: Inadequate calorie and protein intake during critical illness is associated with poor clinical outcomes. Unfortunately, most critically ill patients do not consume adequate levels of these nutrients. An enteral formula with appropriate macronutrient composition may assist patients in meeting nutritional goals. Design: This study was a single center, prospective, observational study of 29 adults in the medical intensive care unit who required enteral nutrition for at least 3 days. Subjects received a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula for up to 5 days to assess the ability to achieve 50% of caloric goals within the first 3 days (primary outcome), the daily percentage of protein goals attained and gastrointestinal tolerance (secondary outcomes). Result: A total of 29 subjects consented and began the study. Four subjects dropped out before first day and 25 subjects were included in analyses. Subjects were aged 55.5 ± 16.9 years with mean body mass index (BMI) of 27.9 ± 7.5 kg/m2. Most (92%) subjects were on a mechanical ventilator and experienced organ failure. At least 50% of caloric and protein goals were achieved in 78.9% and 73.7% of the subjects, respectively, during the first 3 days. Overall, 75.0 ± 26.3% and 69.3 ± 26.7% of calorie and protein goals were achieved using the study formula. Conclusions: Subjects fed enterally with a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula exceeded 50% of caloric and protein goals in most critically ill subjects included in this study. Use of study formula did not lead to severe gastrointestinal intolerance.

Impact of early nutrition and feeding route on clinical outcomes of neurocritically ill patients

“…Adequate calorie and protein intake is important for recovery in critically ill patients [ 33 , 34 ]. Adequate nutritional support may also be important in neurocritically ill patients.…”

Chronic Critical Illness: Current Aspects of the Problem (Review)

“…In this aspect, a nutritive support is an important constituent of the therapy. Besides, enteral nutrition helps maintain structural [ 42 ] and functional condition of the intestine including activation of T-cell association of lymphoid tissue [ 43 ] and activation of neutrophils [ 44 ]. Enteral nutrition allows for preservation of the mucous barrier which prevents translocation of bacteria from the intestinal lumen to the bloodstream and thereby hinders infection from spreading [ 45 ].…”

“…Caloric value should be increased up to 100% by day 7 [ 46 ]. It has been established [ 47 , 48 ] that the increase of calories in the nutrition >70% during the first 12–24 h after the admission to ICRU does not lead to the reduction of hospital stay and better survival.…”

Application of Business Intelligence (BI) To Nutritional Support for Successful Ventilator Weaning

“…Optimizing critical patient nutrition improves clinical outcomes [12][13][14] . This is consistent with our experimental results, which showed that reducing caloric and protein de cits is associated with successful ventilator weaning and signi cantly lower mortality (Fig.…”