Optimal Nutritional Factors Influencing the Duration of Mechanical Ventilation Among Adult Patients with Critical Illnesses in an Intensive Care Unit

Abstract

Objective This study aims to identify the impact of nutritional factors on mechanical ventilation duration for critical patients. Patients and Methods The current study was a single-center, prospective observational design which enrolled one-hundred critically ill patients who were admitted to an intensive care unit (ICU). It demonstrates purposive sampling and also performs the descriptive nutritional factors influencing the mechanical ventilation duration. Daily calories target requirement scale (DCRS), subjective global assessment form (SGA), dyspnea assessment form, and APACHE II have been used as methods in the study along with time to initial enteral nutrition (EN) after 24-hour admission and daily calories target requirement over 7 days to assess patients. Data is analyzed using the multiple regressions. Results As a result, nutritional status monitoring, time to initial EN, calories and target requirements are statistically positive significance associated with the mechanical ventilation duration respectively (R = 0.54, R = 0.30, R= 0.40, p < 0.05). However, age, illness severity, and dyspnea scales are not associated with the mechanical ventilation duration (p> 0.05). Therefore, the nutritional status, malnutrition scores and calorie target requirements can be used to significantly predict the mechanical ventilation duration. The predictive power is 58 and 28.0% of variance. The most proper influencer to predict the mechanical ventilation duration is nutritional status or malnutrition scores. Conclusion The research findings show that the nutritional status, time to initial EN, and calorie target requirement within 7 days of admission are associated with the mechanical ventilation duration in the critical patients. Therefore, it can be used to develop guidelines reducing the mechanical ventilation duration and to promote the ventilator halting for critical patients.

Barriers to Delivery of Enteral Nutrition in Intensive Care Settings in Saudi Arabia: A Comparative Study of the Perceptions of Health Care Providers Working in Adult and Paediatric ICUs

“…The results showed that the most important barrier was "Delay in physician ordering initiation of enteral nutrition" [3.33 ±1.32, 3 (2-5)]which was included in the "delivery of EN" domain. The mean score of this item as indicated by the dietitians was [3.9 ±1.4, 5 (3)(4)(5)], by physicians was [3.09 ±1.1, 3 (2-4)] and by nurses was [3.06 ±1.3, 3 (2-4)]. The second most important barrier was "Waiting for the dietitian to assess the patients" [3.22 ±1.2, 3 (2-4)] which was included in the "dietitian support" domain.…”

“…The second most important barrier was "Waiting for the dietitian to assess the patients" [3.22 ±1.2, 3 (2-4)] which was included in the "dietitian support" domain. The mean score of this item as indicated by the dietitians was [3.5 ±1.4, 4 (2-5)], by physicians was [3.2 ±1.1, 3 (2-4)] and by nurses was [2.79 ±1.1, 3 (2)(3)]. The least important barriers were "Non-ICU physicians requesting patients not be fed enterally" [3.01 ±1.2, 3 (2-4)] preceded by "General belief among ICU team that provision of adequate nutrition does not impact on patient outcome" [3.03 ±1.3, 3 (2-4)]; both barriers were included in the "critical care providers attitude and behaviour" domain.…”

“…Nutrition therapy is a vital element of the care process of critically ill adult and paediatric patients. The prognostic impact of nutrition therapy in the critically ill population has previously been documented in the literature; [1][2][3][4][5] however, achieving optimal nutrition remains a challenge in this population. Although nutrition support either enterally or parenterally has substantially improved the patient's nutritional intake, underfeeding continues to be documented in intensive care settings worldwide.…”

Small bowel feeding: do you pay the price for bypassing the stomach?

“…Furthermore, this guidance is universally recommended unless there are specific exceptions, such as uncontrolled haemodynamic compromise, profound hypoxia, uncontrolled gastro-intestinal bleeding and/or abdominal compartment syndrome [9]. There is demonstrable benefit from optimised nutritional status, time to initial enteral nutrition and meeting calorie target requirements within 7 days of admission, with a significant reduction in time spent undergoing mechanical ventilation if these three factors are optimally achieved [10 ▪ ]. However, early initiation of enteral nutrition has been associated with gastrointestinal intolerance and vomiting in 30–70% of patients in critical care, as well as gut ischemia in critically ill patients with shock [11,12].…”

Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study

“…These indices are widely used to assess nutrition in patients with malignancies [ 7 , 8 ], stroke [ 9 , 10 ], and sepsis [ 11 ]. Moreover, early nutrition status is associated with the duration of mechanical ventilation [ 12 ].…”