Optimal Time and Target for Evaluating Energy Delivery after Adjuvant Feeding with Small Bowel Enteral Nutrition in Critically Ill Patients at High Nutrition Risk.

Wei-Ning Wang,Bor-Jen Lee,Chen-Yu Wang,Pin-Kuei Fu,Mei-Fang Yang,Chiann-Yi Hsu

doi:10.3390/nu11030645

Abstract

Small bowel enteral nutrition (SBEN) may improve nutrient delivery to critically ill patients intolerant of gastric enteral nutrition. However, the optimal time and target for evaluating SBEN efficacy are unknown. This retrospective cohort study investigates these parameters in 55 critically ill patients at high nutrition risk (modified NUTRIC score ≥ 5). Daily actual energy intake was recorded from 3 days before SBEN initiation until 7 days thereafter. The energy achievement rate (%) was calculated as follows: (actual energy intake/estimated energy requirement) × 100. The optimal time was determined from the day on which energy achievement rate reached >60% post-SBEN. Assessment results were as follows: median APACHE II score, 27; SOFA score, 10.0; modified NUTRIC score, 7; and median time point of SBEN initiation, ICU day 8. The feeding volume, energy and protein intake, and achievement rate (%) of energy and protein intake increased significantly after SBEN (p < 0.001). An energy achievement rate less than 65% 3 days after SBEN was significantly associated with increased mortality after adjusting for confounding factors (odds ratio, 4.97; 95% confidence interval, 1.44–17.07). SBEN improves energy delivery in critically ill patients who are still at high nutrition risk after 1 week of stomach enteral nutrition.

Highlights

Gastrointestinal motility disorder is a common problem among critically ill patients, independent of morbidity and mortality [1,2]
The median mNUTRIC score of this cohort was 7 (IQR, 5–8), and the median albumin level was 2.5 g/dL (IQR, 2.2–2.9), indicating that these patients were in the high nutrition risk
Univariate analysis identified only two factors associated with mortality: simplified organ failure assessment (SOFA) score on the 7th ICU3

Summary

Introduction

Gastrointestinal motility disorder is a common problem among critically ill patients, independent of morbidity and mortality [1,2]. Up to 60% of critically ill patients in intensive care units (ICU) are reported to experience gastrointestinal dysmotility, including delayed gastric emptying, abnormal motility patterns, and impaired intestinal barrier integrity requiring therapeutic intervention [2,3]. Patients with an mNUTRIC score ≥5 are defined as ‘high nutrition risk’ and require additional energy intake to reduce mortality [4,5,8]. Our previous study indicates that targeted energy intake is an important predictor of mortality predictor in critically ill patients with high nutrition risk [9]. Previous systematic reviews and meta-analysis have shown that the benefits of early EN include decreased in-hospital mortality, infectious-disease morbidity, and incidence of pneumonia [10,11,12,13]

Methods

Results

Conclusion