Adequacy of Protein and Energy Intake in Critically Ill Adults Following Liberation From Mechanical Ventilation Is Dependent on Route of Nutrition Delivery

Abstract

Background Studies examining nutrition intake of critically ill patients following liberation from mechanical ventilation (LMV) are scarce. The objectives of this prospective, observational feasibility study were to quantify and assess protein and energy intake in hospitalized, critically ill patients following LMV, to determine barriers to optimal intake, and to report on the feasibility of recruiting and retaining patients into this study. Methods Adult patients requiring MV for >72 hours in a medical/surgical intensive care unit (ICU) were recruited. Protein and energy intakes were quantified up to 14 days following LMV. Patients also identified barriers to eating. Results Nineteen patients (mean age, 60 years [SD, 12 years]) were studied over 125 days. Over all study days, the median amounts of protein and energy consumed in comparison with amounts prescribed by dietitians were 46% (interquartile range [IQR], 26–100) and 71% (IQR, 38–100), respectively. When stratified by route of nutrition delivery, on days (n = 54) when patients consumed an oral diet as the sole nutrition source, median amounts of protein and energy consumed in comparison with those prescribed were only 27% (IQR, 15–41) and 47% (IQR, 29–66), respectively. The most frequently reported barriers to eating were poor appetite, early satiety, and taste changes. Conclusions Protein and calorie intake is below prescribed amounts for patients whose enteral nutrition is discontinued and an oral diet prescribed as sole nutrition source following LMV. Acceptable strategies to enhance nutrition intake in post‐ICU patients during the recovery stages of critical illness are needed.

Nutrition Management for Critically Ill Adult Patients Requiring Non-Invasive Ventilation: A Scoping Review

“…In other non-mechanically ventilated critically ill populations, oral intake in isolation has been demonstrated to be inadequate to meet nutrition requirements. In the first 7–14 days post-extubation, patients that progress to oral intake meet <50% of EER [ 37 , 38 ]. ICU survivors within the post-ICU acute ward setting also experience inadequate oral nutrition, meeting 37% (interquartile range (IQR) 21–67%) of predicted energy requirements [ 39 ].…”

Protocol summary and statistical analysis plan forIntensiveNutritionTherapy comparEd to usual care iNcriTically ill adults (INTENT): a phase II randomised controlled trial

“…Although it is plausible that nutrition may be important, the limited data available indicate that both energy and protein intake during this period is worse than in the early ICU period for factors relating to patients, clinicians and system issues. [9][10][11][12][13][14][15] A cumulative energy deficit because of inadequate energy delivery after ICU discharge, coupled with the deficits observed during the ICU period, may be an explanation for the lack of benefit observed in critical care nutrition trials to date.…”

“…Later in intensive care unit (ICU) stay and throughout the subsequent hospital admission may be a time when the amount of energy and protein is important for recovery, with metabolism changing to allow exogenous nutrition to be processed. Although it is plausible that nutrition may be important, the limited data available indicate that both energy and protein intake during this period is worse than in the early ICU period for factors relating to patients, clinicians and system issues 9–15. A cumulative energy deficit because of inadequate energy delivery after ICU discharge, coupled with the deficits observed during the ICU period, may be an explanation for the lack of benefit observed in critical care nutrition trials to date.…”

Oral Nutrition during and after Critical Illness: SPICES for Quality of Care!

“…According to the few studies published so far, critically ill patients who were fed orally had very low intakes in term of both energy and proteins, compared to predicted requirements and recommendations [5,[16][17][18][19][20], regardless of the underlying cause. In the different studies, energy intakes varied from 30 to 50% of the daily requirement or prescription.…”