Adequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors?

Abstract

Objective To determine the factors that influence the adequacy of enteral nutritional therapy in an intensive care unit.Methods This prospective observational study was conducted in an intensive care unit between 2010 and 2012. Patients >18 years of age underwent exclusive enteral nutritional therapy for ≥72 hours. The energy and protein requirements were calculated according to the ICU protocols. The data regarding enteral nutrition, the causes of non-compliance, and the biochemical test results were collected daily.Results Ninety-three patients admitted to the intensive care unit were evaluated. Among these patients, 82% underwent early enteral nutritional therapy, and 80% reached the nutritional goal in <36 hours. In addition, 81.6%±15.4% of the enteral nutrition volume was infused, with an adequacy of 82.2%±16.0% for calories, 82.2%±15.9% for proteins, and a mean energy balance of -289.9±277.1kcal/day. A negative correlation of C-reactive protein with the volume infused and the energy and protein balance was observed. In contrast, a positive correlation was found between C-reactive protein and the time required to reach nutritional goals. Extubation was the main cause for interrupting the enteral nutritional therapy (29.9% of the interruption hours), and the patients >60 years of age exhibited a lower percentage of recovery of the oral route compared with the younger patients (p=0.014).Conclusion Early enteral nutritional therapy and the adequacy for both energy and protein of the nutritional volume infused were in accordance with the established guidelines. Possible inadequacies of energy and protein balance appeared to be associated with an acute inflammatory response, which was characterized by elevated C-reactive protein levels. The main cause of interruption of the enteral nutritional therapy was the time spent in extubation.

Inadequação calórica e proteica e fatores associados em pacientes graves

“…Entre os pacientes críticos, existe uma prevalência de desnutrição superior a 35% já na admissão em UTI. Isso também ocorre dentro do ambiente hospitalar, porém, na maioria das vezes, com maior intensidade devido à coexistência de fatores de risco 2 , variando entre 43 e 88% 3 .…”

“…O paciente crítico é tipicamente associado a um estado de estresse catabólico e a uma resposta inflamatória sistêmica. Essa resposta está relacionada a complicações que levam ao aumento da morbidade infecciosa, da disfunção múltipla de órgãos, da hospitalização prolongada e da taxa de mortalidade [2][3][4][5] .…”

“…Dessa maneira, a resposta metabólica ao estresse diminui, evitando a lesão celular oxidativa [1][2][3][4][5][6] .…”

Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients "at nutritional risk"

“…Oliveira Filho et al (30), encountered an average of > 80% of adequacy in infused ENT volume in oncological patients with NUTRIC > 6 and under MV, while Couto et al (33) showed values < 80% in politrauma patients and also under MV. In intensive care, to manage that patients receive a proper amount of prescribed ENT is a daily struggle, considering gastrointestinal intolerance such as abdominal distension, diarrhea and vomit or even pauses for procedures such as extubation or surgeries (30,34). Discrepancies observed between prescribed and infused volume had been reported by several authors as one of the main factors for hypoalimentation (5,18,19,29).…”

“…The constant presence of the family and relatives during ICU stay might contribute to an increase in oral intake, mainly for elderly patients, because those are the ones who probably display a smaller percentage of oral intake recovery when compared to adult patients (34).…”