Influence of Nutritional Management and Rehabilitation on Physical Outcome in Japanese Intensive Care Unit Patients: A Multicenter Observational Study

Abstract

Background: There is lack of evidence regarding nutritional management among intensive care unit (ICU) patients in a population with relatively low body mass index. Therefore, we conducted an observational study to assess the nutritional management in Japanese ICUs. Also, we investigated the impact of nutritional management and rehabilitation on physical outcome. Methods: The study population comprised 389 consecutive patients who received mechanical ventilation for at least 24 h and those admitted to the ICU for > 72 h in 13 hospitals. The primary outcomes were caloric and protein intake in ICU on days 3 and 7, and at ICU discharge. The secondary outcome was the impact of nutritional management and rehabilitation on physical status at ICU discharge. We defined good physical status as more than end sitting and poor physical status as bed rest and sitting. We divided the participants into 2 groups, namely, the good physical status group (Good group) and poor physical status group (Poor group) for analysis of the secondary outcome. Data were expressed as median (interquartile range). Results: The median amount of caloric intake on days 3 and 7, and at ICU discharge via enteral and parenteral routes were 8.4 (3.1–15.6), 14.9 (7.5–22.0), and 11.2 (2.5–19.1) kcal/kg/day, respectively. The median amount of protein intake on days 3 and 7, and at ICU discharge were 0.2 (0–0.5), 0.4 (0.1–0.8), and 0.3 (0–0.7) g/kg/day, respectively. The amount of caloric intake on day 3 in the Poor group was significantly higher than that of the Good group (10.1 [5.8, 16.2] vs. 5.2 [1.9, 12.4] kcal/kg/day, p < 0.001). The proportion of patients who were received rehabilitation in ICU in the Good group was significantly higher than that of the Poor group (92 vs. 63%, p < 0.001). The multivariate analysis revealed that caloric intake on day 3 and rehabilitation in ICU were considered independent factors that affect physical status (OR 1.19; 95% CI 1.05–1.34; p = 0.005 and OR 0.07; 95% CI 0.01–0.34; p = 0.001). Conclusions: The caloric and protein intakes in Japanese ICUs were 15 kcal/kg/day and 0.4 g/kg/day, respectively. In addition, critically ill patients might benefit from low caloric intake (less than 10 kcal/kg/day) until day 3 and rehabilitation during ICU stay.

Accuracy of Computed Equations for Predicting the Resting Energy Requirements in Patients with Generalized Secondary Peritonitis

“…No statistically significant differences between groups were found (P=0.362). According to earlier studies, the daily energy expenditure converted to BW kg in critically ill patients was approximately the same [13]. Regardless on the method of determining REE, it was higher in patients on MLV vs. spontaneously breathing patients, though that difference was not statistically significant (table 3).…”

“…The peak value, peak time, and total duration of metabolic alterations depend on disease severity and peculiarities of its course. During this period, REE increases approximately by 20-80% over the norm [13]. Given that in immobilized critically ill patients REE rises 1.1-1.2-fold and in case of exhaustion the increase might be 1.3-fold, we chose 1.25 as the correction factor for the HB formula [8].…”

“…In our study, the mean daily energy expenditure of a GSP patient amounted to 25.78 kcal/kg/day. According to the modern science, to make up energy expenditure in full, a patient receiving intensive care requires 25 kcal/kg/day [10,13]. The percent of exact measurements in application of this formula to the patients of arms 2 and 3 was just over 60% (table 5).…”

“…Taking into account that in our study the body weight index varied between 19 kg/m 2 and 32.3 kg/m 2 , we decided to determine whether the REE can be assessed if we multiply BW id by 25 rather than BW ac mentioned in the current guidelines [10]. Analysis has shown that the results were exact only in one third of the pa- [10,13]. Процент точных измерений при использовании этой формулы у пациентов 2-й и 3-й групп был чуть выше 60% (табл.…”

“…При пересчете на МТ ф были получены следующие результаты: 25,78±1,37 ккал/кг/сут -в 1-й группе; 25,23±1,45 ккал/кг/сут -во 2-й и 26,98±1,16 ккал/кг/сут -в 3-й, которые также статистически значимо не отличались между собой (р=0,362). Согласно предыдущим исследованиям, суточная потребность в энергии, в перерасчете на килограмм МТ, у пациентов в критическом состоянии была примерно аналогичной [13]. Вне зависимости от способа определения REE, в группе больных на ИВЛ она была больше, чем у пациентов на самостоятельном дыхании, хотя эти отличия были статистически не значимыми (табл.…”