Nutritional management of ICU patients receiving mechanical ventilation: A retrospective cohort study using a medical claims database

Abstract

<h2>Summary</h2><h3>Background & aims</h3> Because nutritional therapy affects clinical outcomes in critically ill patients, the nutritional management of such patients must be appropriate. However, the nutritional management of critically ill patients in Japan has not been fully characterized. The aim of this study was to describe the nutritional management of inpatients admitted to Japanese intensive care units using a national medical claims database. <h3>Methods</h3> In this retrospective cohort study, we included mechanically ventilated adult patients who were admitted to an ICU in Japan from January 2010 through June 2020 and remained there ≥ 4 days. We determined when nutritional management (i.e., oral intake, enteral nutrition, or parenteral nutrition) was initiated and how that changed during days 1–30. We also identified the prescribed daily doses of parenteral energy, amino acids, and lipids during fasting period from days 1–30. <h3>Results</h3> Of 99147 patients, 28435 (28.7%) were aged ≥ 80 and 16737 (16.9%) had BMI < 18.5. The median (Q1, first quartile; Q3, third quartile) initiation of enteral nutrition was day 4 (2, 6). Of this cohort, 37240 (37.6%) and 73563 (74.2%) patients took food orally or received enteral nutrition on days 3 and 7, respectively; whereas, 89542 (90.3%) and 25584 (25.8%) patients received only parenteral nutrition or glucose/electrolyte infusions on days 1 and 7, respectively. For fasting patients, the prescribed parenteral energy dose began increasing on day 2 and the median (Q1, Q3) dose on day 7 was 10.7 (4.5, 18.9) kcal/kg; prescribed amino acid dose began increasing on day 5 and the median (Q1, Q3) dose on day 7 reached 0.32 (0.00, 0.62) g/kg; and median (Q1, Q3) prescribed lipid caloric proportion of non-protein energy was 8.0% (0.0%, 34.4%) on day 1 and 0.0% after that. <h3>Conclusions</h3> Fasting critically ill patients in Japan were prescribed inadequate doses of parenteral amino acids relative to doses recommended in nutritional guidelines, and almost all of these patients had no parenteral lipids prescribed. The results of this survey of nutritional management in real-world settings should serve as a foundation for future studies determining optimal nutritional management of critically ill patients. <h3>Trial registration</h3> UMIN clinical trial registry, the Japanese clinical trial registry (registration number: UMIN000042607). Registered 1 December 2020 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048553.