Impact on calculated energy requirements when estimating height using ulna length versus visual height estimation for critically ill patients with covid-19

• Background Inadequate nutritional intake in critically ill patients can lead to complications resulting in increased mortality and healthcare costs. Several factors limit adequate nutritional intake in intensive care unit patients given enteral feedings. • Objective To examine the adequacy of enteral nutritional intake and the factors that affect its delivery in patients receiving mechanical ventilation. • Methods A prospective, descriptive design was used to study 60 patients receiving enteral feedings at target or goal rate. Energy requirements were determined for the entire sample by using the Harris-Benedict equation; energy requirements for a subset of 25 patients were also determined by using indirect calorimetry. Energy received via enteral feeding and reason and duration of interruptions in feedings were recorded for 3 consecutive days. • Results Mean estimated energy requirements (8996 kJ, SD 1326 kJ) and mean energy intake received (5899 kJ, SD 3058 kJ) differed significantly (95% CI 3297-3787; P < .001). A total of 41 patients (68.3%) received less than 90% of their required energy intake, 18 (30.0%) received within ±10%, and 1 (1.7%) received more than 110%. Episodes of diarrhea, emesis, large residual volumes, feeding tube replacements, and interruptions for procedures accounted for 70% of the variance in energy received (P<.001). Procedural interruptions alone accounted for 45% of the total variance. Estimated energy requirements determined via indirect calorimetry and mean energy received did not differ. • Conclusions Most critically ill patients receiving mechanical ventilation who are fed enterally do not receive their energy requirements, primarily because of frequent interruptions in enteral feedings.

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Nutritional requirements of surgical and critically-ill patients: do we really know what they need?

Proceedings of The Nutrition Society ◽

10.1079/pns2004312 ◽

2004 ◽

Vol 63 (3) ◽

pp. 467-472 ◽

Cited By ~ 51

Author(s):

Clare L. Reid

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Surgical Patients ◽

Energy Requirements ◽

Surgical Patient ◽

Everyday Clinical Practice ◽

Protein Requirements ◽

Heterogeneous Nature ◽

Patient Groups ◽

Poor Nutrition

Malnutrition remains a problem in surgical and critically-ill patients. In surgical patients the incidence of malnutrition ranges from 9 to 44%. Despite this variability there is a consensus that malnutrition worsens during hospital stay. In the intensive care unit (ICU), 43% of the patients are malnourished. Although poor nutrition during hospitalisation may be attributable to many factors, not least inadequacies in hospital catering services, there must also be the question of whether those patients who receive nutritional support are being fed appropriately. Indirect calorimetry is the ‘gold standard’ for determining an individual's energy requirements, but limited time and financial resources preclude the use of this method in everyday clinical practice. Studies in surgical and ICU patient populations have been reviewed to determine the ‘optimal’ energy and protein requirements of these patients. There are only a small number of studies that have attempted to measure energy requirements in the various surgical patient groups. Uncomplicated surgery has been associated with energy requirements of 1·0–1·15×BMR whilst complicated surgery requires 1·25–1·4×BMR in order to meet the patient's needs. Identifying the optimal requirements of ICU patients is far more difficult because of the heterogeneous nature of this population. In general, 5·6 kJ (25 kcal)/kg per d is an acceptable and achievable target intake, but patients with sepsis or trauma may require almost twice as much energy during the acute phase of their illness. The implications of failing to meet and exceeding the requirements of critically-ill patients are also reviewed.

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