Abstract
Background: insufficient feeding is frequent in the intensive care unit (ICU), which results in poor outcomes. Little is known about the nutrition pattern of patients requiring prolonged ICU stays. The aims of our study are to describe the demographic, metabolic, and nutritional specificities of chronically critically ill (CCI) patients defined by an ICU stay >2 weeks, and to identify an early risk factor. Methods: analysis of consecutive patients prospectively admitted to the CCI program, with the following variables: demographic characteristics, Nutrition Risk Screening (NRS-2002) score, total daily energy from nutritional and non-nutritional sources, protein and glucose intakes, all arterial blood glucose values, length of ICU and hospital stay, and outcome (ICU and 90-day survival). Two phases were considered for the analysis: the first 10 days, and the next 20 days of the ICU stay. Statistics: parametric and non-parametric tests. Results: 150 patients, aged 60 ± 15 years were prospectively included. Median (Q1, Q3) length of ICU stay was 31 (26, 46) days. The mortality was 18% at ICU discharge and 35.3% at 90 days. Non-survivors were older (p = 0.024), tended to have a higher SAPSII score (p = 0.072), with a significantly higher NRS score (p = 0.033). Enteral nutrition predominated, while combined feeding was minimally used. All patients received energy and protein below the ICU’s protocol recommendation. The proportion of days with fasting was 10.8%, being significantly higher in non-survivors (2 versus 3 days; p = 0.038). Higher protein delivery was associated with an increase in prealbumin over time (r2 = 0.19, p = 0.027). Conclusions: High NRS scores may identify patients at highest risk of poor outcome when exposed to underfeeding. Further studies are required to evaluate a nutrition strategy for patients with high NRS, addressing combined parenteral nutrition and protein delivery.
Highlights
The intensive care unit (ICU) patient population has evolved over the last two decades with the appearance of an increasing number of patients requiring very long ICU stays, lasting up to several months after surviving the initial acute insult [1]
The present study aims to describe the metabolic and nutritional specificities of these patients, to analyze those associated with poor outcome, and to identify a factor that might enable early detection of critical illness (CCI) risk
589 patients were admitted who required ICU for >7 days, but the majority were discharged before entering the PLS program
Summary
The intensive care unit (ICU) patient population has evolved over the last two decades with the appearance of an increasing number of patients requiring very long ICU stays, lasting up to several months after surviving the initial acute insult [1]. A long stay is usually defined as the requirement of more than one week of mechanical ventilation (MV) and of ICU therapy, but different definitions have been used [2]. Chronic critical illness (CCI) is the most frequent designation for these patients, which is characterized by lengthy hospital stays, intense suffering, high mortality rates, and substantial resource consumption [3]. In the ICU, mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index (BMI) have been identified as independent predictors of this condition [6]
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