Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study

Abstract

Background: The impact of protein intake on outcomes in pediatric critical illness is unclear. Objective: We examined the association between protein intake and 60-d mortality in mechanically ventilated children. Design: In a prospective, multicenter, cohort study that included 59 pediatric intensive care units (PICUs) from 15 countries, we enrolled consecutive children (age: 1 mo to 18 y) who were mechanically ventilated for $48 h. We recorded the daily and cumulative mean adequacies of energy and protein delivery as a percentage of the prescribed daily goal during the PICU stay #10 d. We examined the association of the adequacy of protein delivery with 60-d mortality and determined variables that predicted protein intake adequacy. Results: We enrolled 1245 subjects (44% female) with a median age of 1.7 y (IQR: 0.4, 7.0 y). A total of 985 subjects received enteral nutrition, 354 (36%) of whom received enteral nutrition via the postpyloric route. Mean 6 SD prescribed energy and protein goals were 69 6 28 kcal/kg per day and 1.9 6 0.7 g/kg per day, respectively. The mean delivery of enteral energy and protein was 36 6 35% and 37 6 38%, respectively, of the prescribed goal. The adequacy of enteral protein intake was significantly associated with 60-d mortality (P , 0.001) after adjustment for disease severity, site, PICU days, and energy intake. In relation to mean enteral protein intake ,20%, intake $60% of the prescribed goal was associated with an OR of 0.14 (95% CI: 0.04, 0.52; P = 0.003) for 60-d mortality. Early initiation, postpyloric route, shorter interruptions, larger PICU size, and a dedicated dietitian in the PICU were associated with higher enteral protein delivery. Conclusions: Delivery of .60% of the prescribed protein intake is associated with lower odds of mortality in mechanically ventilated children. Optimal prescription and modifiable practices at the bedside might enhance enteral protein delivery in the PICU with a potential for improved outcomes. This trial was registered at clinicaltrials.gov as NCT02354521.

Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU*

“…Study methods have been previously described [11] and were the identical for two surveys [12]. Site investigators in participating PICUs with 8 or more beds collected demographic, clinical, and nutritional data on consecutively admitted mechanically ventilated children aged 1 month to 18 years with an expected stay of 3 or more days.…”

Enteral Nutrition and Acid-Suppressive Therapy in the PICU: Impact on the Risk of Ventilator-Associated Pneumonia*

“…Data were prospectively collected as part of the second Pediatric International Nutrition Study (PINS2) with VAP as an a priori identified outcome. Participation, recruitment and data collection methods for the PINS2 study have been previously reported (9). In brief, participating sites recruited consecutive subjects, age 1 month to 18 years, who required mechanical ventilation and had an anticipated PICU stay >48 hours.…”

Treatment and management of children with haemolytic uraemic syndrome

“…Early initiation of adequate enteral feeds in critical illness is linked to a decrease in short-term and long-term mortality 25. This is especially important in AKI as children are in a highly catabolic state, potentially contributing to further metabolic derangement, including uraemia.…”