INTENSIV-News
A prospective survey of nurtitional support practices in intensive care unit patients. What is prescribed? What is delivered?
Bernard De Jonghe, Corinne Appere-De-Vechi, Muriel Fournier, et al., Crit Care Med 2001; 29:8-12
Sevice de Reanimation Medicale, Hopital de Poissy-Saint-Germain, Poissy, France
OBJECTIVES:
To assess the amount of nutrients delivered, prescribed, and required
for critically ill patients and to identify the reasons for iscrepancies
between prescriptions and requirements and between prescriptions and
actueal delivery of nutrition.
DESIGN: Prospective cohort study.
SETTING: Twelve-bed medical intensive care unit in a university-affiliated general hospital.
PATIENTS:
Fifty-one consecutive patients, receiving nutritional support either
enterally or intravenously for 2 days. We followed patients for the
first 14 days of nutritional delivery.
MEASUREMENTS AND MAIN RESULTS:
The amount of calories prescribed and the amount actually delivered
were recorded daily and compared with the theoretical energy
requirements. A combined regimen of enteral and parenteral nutrition was
administered on 58% of the 484 nutrition days analyzed, and 63,5% of
total caloric intake was delivered enterally. Seventy-eight percent of
the mean caloric amount required was prescribed, and 71% was effectively
delivered. The amount of calories actually delivered compared with the
amount prescribed was significantly lower in enteral than in parenteral
administration (86.8% vs. 112.4% p < .001). Discrepancies between
prescription and delivery of enterally administered nutrients were
attributabel to interruptions caused by digestive intolerance (27.7%,
mean daily wasted volume 641 mL), airway management (30.8%, wasted
volume 745 mL), and diagnostic procedures (26.6%, wasted volume 567 mL).
Factors significantly associated with a low prescription rate of
nutritional support were the administration of vasoactive drugs, central
venous catheterization, and the need for extrarenal replacement.
CONCLUSIONS:
An inadequate delivery of enteral nutrition and a low rate of nutrition
prescription resulted in low caloric intake in our intensive care unit
patients. A large volume of enterally administered nutrients was wasted
because of inadequate timing in stopping the restarting enteral feeding.
The inverse correlation between the prescription rate of nutrition and
the Intensity of care required suggests that physicians need to pay more
attention to providing appropriate nutritional support for the most
severely ill patients.
Renaissance der parenteralen Ernährung in der Intensivmedizin?
Wir
alle haben in den letzten 15 Jahren den Siegeszug der enteralen
Ernährung bei Intensivpatienten mitgemacht und mitgetragen. Der
Intestinaltrakt wurde als ein wesentliches Organsystem für den
Intensivpatienten erkannt, die enterale Ernährung die wesentlichste
Maßnahme zur Aufrechterhaltung der intenstinalen Funktionen
identifiziert. Ganz klar wurde gezeigt, dass eine enterale gegenüber
einer rein parenteralen Ernährung die Ausbildung infektiöser
Komplikationen vermindern helfen kann, eine wichtige Maßnahme zur
Reduktion der inflammatorischen Reaktion und der Stimulation der
Immunkompetenz des Organismus darstellt.
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