How does a previous icu stay modify nutrition support in the wards: a risk adjusted evaluation from 191 886 adult patients from nutritionday 2006-2019

Introduction: Number of recently published studies on nutritional support in the intensive care unit (ICU) have resulted in a paradigm shift of clinical practices. This review summarises the latest evidence in four main topics in the ICU, namely: (1) function of validated nutrition screening/assessment tools, (2) types and validity of body composition measurements, (3) optimal energy and protein goals, and (4) delivery methods. Methods: Recent studies that investigated the above aims were outlined and discussed. In addition, recent guidelines were also compared to highlight the similarities and differences in their approach to the nutrition support of critically ill patients. Results: Regardless of nutritional status and body composition, all patients with >48 hours of ICU stay are at nutrition risk and should receive individualised nutrition support. Although a recent trial did not demonstrate an advantage of indirect calorimetry over predictive equations, it was recommended that indirect calorimetry be used to set energy targets with better accuracy. Initiation of enteral nutrition (EN) within 24–48 hours was shown to be associated with improved clinical outcomes. The energy and protein goals should be achieved gradually over the first week of ICU stay. This practice should be protocolised and regularly audited as critically ill patients receive only part of their energy and protein goals. Conclusions: Metabolic demands of critically ill patients can be variable and nutrition support should be tailored to each patient. Given that many nutrition studies are on-going, we anticipate improvements in the individualisation of nutrition support in the near future. Key words: Critical care, Critical illness, Intensive care, Nutrition, Nutritional intake, Nutrition support

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Positive fluid balance within the first 72 hours in the intensive care unit is associated with higher mortality in adult patients

Research Society and Development ◽

10.33448/rsd-v10i14.22377 ◽

2021 ◽

Vol 10 (14) ◽

pp. e498101422377

Author(s):

Natália Linhares Ponte Aragão ◽

Arnaldo Aires Peixoto Júnior ◽

Carlos Augusto Ramos Feijó ◽

Marina Parente Albuquerque ◽

Francisco Albano de Meneses

Keyword(s):

Fluid Balance ◽

Adult Patients ◽

Independent Factor ◽

Risk Of Death ◽

Icu Stay ◽

Tertiary Teaching ◽

Observational Cohort ◽

Tertiary Teaching Hospital ◽

Optimal Cutoff Point ◽

Relative Risk Of Death

Objective: To identify the association between cumulative fluid balance in the first 72 hours of ICU stay and outcomes. Methodology: retrospective observational cohort with data analysis of adult patients hospitalized in an ICU of a tertiary teaching hospital. Results: a total of 86 patients who remained in the ICU for more than 72 hours were evaluated. The fluid balance in the first 72 hours was higher in the subgroup of patients who died in the ICU (5210.3 ± 2787.7 vs. 3017.4 ± 2847.2 mL, p = 0.004). The fluid balance in the first 72 hours was an independent factor directly associated with death in the ICU (OR: 1,000; p = 0.009). The area under the ROC curve was 0.7119 (95% CI: 0.58-0.84, p = 0.005). The optimal cutoff point for the fluid balance in the first 72 hours as a predictor of death in the ICU was + 3.900mL and the relative risk of death among those who presented a fluid balance higher than this value was 1.702 (95% CI: 1, 15-2.53, p = 0.009). Conclusion: an association was identified between the cumulative value in the fluid balance in the first 72 hours of ICU stay and the highest risk of death, which is an independent factor of the patient's severity at admission.

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Are we Giving Sufficient Protein in Parenteral Nutrition Support? A Cross-sectional Study on Adult Patients in Intensive Care Units

Journal of Pharmacy Practice and Community Medicine ◽

10.5530/jppcm.2021.2.6 ◽

2021 ◽

Vol 7 (2) ◽

pp. 24-27

Author(s):

Pui Wun Fiona Fong ◽

Mahmud Majdi bin Mahmud Saedon ◽

Stella Caroline J Bangguan

Keyword(s):

Intensive Care ◽

Parenteral Nutrition ◽

Intensive Care Units ◽

Cross Sectional Study ◽

Adult Patients ◽

Nutrition Support ◽

Sectional Study ◽

Cross Sectional

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Trend Observations in Home Parenteral Nutrition. Prevalence, Hospitalizations and Costs: Results from a Nationwide Analysis of Health Care Provider Data

Nutrients ◽

10.3390/nu13103465 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3465

Author(s):

Marcin Folwarski ◽

Stanisław Kłęk ◽

Agnieszka Szlagatys-Sidorkiewicz ◽

Adam Wyszomirski ◽

Michał Brzeziński ◽

...

Keyword(s):

Health Care ◽

Parenteral Nutrition ◽

Age Distribution ◽

Specific Area ◽

Fold Increase ◽

Home Parenteral Nutrition ◽

Adult Patients ◽

Nutrition Support ◽

Gi Symptoms ◽

Risk Rate

Background: The population of patients on home parenteral nutrition (HPN) worldwide is growing. Since only a few counties provide data from national registries long-term observations are valuable to address this specific area of nutrition support. This study is a nationwide analysis determining the trends in the epidemiology of HPN (prevalence, age distribution, death rates), indications for HPN, causes for hospitalizations, and cost analysis of HPN reimbursement in Poland between 2010–2020. Methods: A retrospective analysis of data obtained from the national health fund (NHF) of Poland on adult patients on HPN. Results: The prevalence of adult patients on HPN in Poland in 2020 was 53.26 per million citizens with a 2.99-fold increase and a growing trend observed from 2010. Significant decrease in the percentage of patients between 18–34, 45–54 and an increase in patients between 65–74 and patients over 75 years old was observed. Trend analysis showed an increase in new patients between 65–74 and a decrease between 35–54. Malnutrition (34.28%), postprocedural disorders of the GI tract (19.61%), intestinal malabsorption/other intestinal diseases (20.41%) and GI obstruction due to cancer (17.36% as primary and 23.16% as secondary diagnosis) were mostly reported as the primary indications for HPN. Cancer patients were mostly gastric, ovarian and colon cancer (34.74%, 17.83% and 12.3%). HPN and total health cost reimbursement increase was 2.6 and 2.57—fold respectively. Costs of HPN and total health care costs in 2020 per patient were € 10,015 and € 16,038, respectively. Overall death risk rate during the first year of nutrition was 0.59 with a significant increase in the observation period p-trend < 0.004. A significant increase in the death rate was observed in patients above 75 years old (estimate 1.629, p-trend < 0.030). Cancer, infection, malnutrition and GI symptoms were the most common indications for hospitalizations of HPN patients. The rate of patients with a maximal length of HPN of 5 months in 2010 was 54.9% and was growing up to 78.1% in 2020. Conclusions: The prevalence of HPN in Poland is growing. Trends of age distribution show increasing numbers of patients with more advanced age and shorter survival. Costs of HPN are comparable with other European data.

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