Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit*

Rubinson, Lewis; Diette, Gregory B.; Song, Xiaoyan; Brower, Roy G.; Krishnan, Jerry A.

doi:10.1097/01.ccm.0000089641.06306.68

Cited by 338 publications

(222 citation statements)

References 42 publications

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“…The study, which investigated the impact of energy deficits on the microbiological results of blood cultures of long-term severely ill mechanical ventilation patients, confirms previous publications associating large energy deficits with infectious complications [12]. Interestingly, the cumulated energy deficits for patients developing methicillin-resistant Staphylococcus aureus blood stream infections (MRSA-BSI) were greater ([-300 kcal/day more) than those with ICU BSI caused by other pathogens.…”

supporting

confidence: 83%

Nutrition in the ICU: proof of the pudding is in the tasting

Singer

Cohen

2014

Intensive Care Med

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supporting

confidence: 83%

Nutrition in the ICU: proof of the pudding is in the tasting

Singer

Cohen

2014

Intensive Care Med

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“…Other factors related to malnutrition are decreased wound healing and tissue maintenance (White et al, 2012). According to a study by Rubinson, Diette, Song, Brower, and Krishnan (2004), patients that received less than 25% of their recommended calories a day were at an increased risk for nosocomial blood stream infections.…”

Section: Discussionmentioning

confidence: 99%

“…According to a study by Rubinson, Diette, Song, Brower, and Krishnan (2004), patients that received less than 25% of their recommended calories a day are associated with an increased risk for nosocomial blood stream infections.…”

Section: Enteral Feeding: Modes Of Deliverymentioning

confidence: 99%

Do Patients in the Intensive Care Unit Receive Recommended Total Daily Calories with Enteral Feedings Using a Rate Based Protocol?

Schaefer

2015

Preprint

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When a patient is unable to eat or eat enough nutrients due to an illness or surgery, nutrition from another source may be required. Supplemental nutrition may be given in the form of enteral nutrition. The current practice is delivering enteral feedings on a rate based protocol to deliver calculated required calories over a specific length of time.Patients who receive enteral nutrition may have feedings interrupted due to a variety of reasons such as a procedure or diagnostic exam. Interruptions reduce the total daily calories delivered. If a patient does not achieve their total daily calories, it can be detrimental to the patient's health and may increase length of stay and costs of hospitalization. The purpose of this study was to determine if patients receive their recommended total daily calories of enteral nutrition using a rate based protocol. A retrospective research design was used to obtain data from patients who received enteral feedings while in the Intensive Care Unit. Data were collected on patients who were admitted to the unit between June 1, 2014 and August 31, 2014. 41 patients who received enteral feedings were included in this study. 80% of patients had their enteral feedings interrupted; most frequent reasons included diagnostic testing, residual volumes and procedures. Interruptions of the enteral feedings lasted between one hour and 24 hours in duration with a mean of 2.9 hours. The most frequent duration of interruption was one hour. Patients received a mean of 56.4% of their daily prescribed goal calories and 56.7% of their daily prescribed volume of enteral feedings. This study suggests that patients do not receive their daily prescribed calories using a rate based protocol.Recommendations for further research and advanced nursing practice are discussed.

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“…Some papers have shown that in critical care settings, underfeeding related to inability to deliver the required nutrients is very common. Repetitive fasting periods, enteral tube complications, and gastrointestinal intolerance are the most frequent reported problems (4)(5)(6)(7)(8)(9)(10)(11). A multicentric study showed that the greater quantity of calories and proteins delivered the more significant clinical improvement is found especially in patients with body mass index (BMI) lower than 25 kg/m² or greater than 35 kg/m² (12).…”

Section: Introductionmentioning

confidence: 99%

“…Energy deficit is common in intensive care but only a few studies have correlated it with mortality among critically ill patients (5,6,11). In this context new data may enhance the perceptions of intensive care physicians on this important issue.…”

Section: Introductionmentioning

confidence: 99%

Déficit crítico de energía y mortalidad en pacientes críticos

Siqueira-Paese¹,

Dock-Nascimento

Aguilar-Nascimento

2016

Nutr Hosp

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ResumenObjetivo: investigar la infl uencia del défi cit de calorías y proteínas en la mortalidad y la duración de la estancia hospitalaria de pacientes críticos. Métodos: se realizó un estudio prospectivo de cohorte incluyendo 100 pacientes consecutivos en una unidad de cuidados intensivos (UCI) terciaria que recibían nutrición enteral o parenteral. Se registraron diariamente los défi cits de calorías y proteínas durante un máximo de 30 días. Los défi -cit de energía y proteínas fueron divididos en: défi cit crítico de calorías (≥ 480 kcal/día), défi cit calórico no crítico (≤ 480 kcal/día), défi cit crítico de proteínas (≥ 20 g/día) y défi cit de proteínas no crítico (≤ 20 g/día). Los resultados se correlacionaron con la estancia hospitalaria y la mortalidad. Resultados: la tasa de mortalidad fue de 33%. En general, los pacientes recibieron 65,4% y 67,7% de las necesidades calóricas y proteicas. El défi cit calórico crítico se encontró en el 72% de los casos y el défi cit proteico crítico en el 70% de ellos. Hubo una correlación signifi cativa entre la duración de la estancia con el défi cit calórico (R = 0,37; p < 0,001) y el défi cit de proteínas (R = 0,28; p < 0,001). El análisis de sobrevida mostró que la mortalidad fue mayor en los pacientes con défi cit calórico crítico (p < 0,001) o con défi cit proteico crítico (p < 0,01). El análisis de regresión de Cox mostró que el défi cit crítico de proteínas se asoció con mayor mortalidad (HR 0.25, IC 95% 0,07-0,93; p = 0,03). Conclusiones: la incidencia de défi cit de calorías y de proteínas en la UCI es alta. Tanto los défi cit calóricos como proteicos aumentan la duración de la estancia hospitalaria, y el défi cit de proteínas superior a 20 g/día es un factor independiente de mortalidad en la ICU. AbstractObjective: We investigate the infl uence of caloric and protein defi cit on mortality and length of hospital stay of critically ill patients. Methods: A cohort prospective study including 100 consecutive patients in a tertiary intensive care unit (ICU) receiving enteral or parenteral nutrition. The daily caloric and protein defi cit were collected each day for a maximum of 30 days. Energy defi cits were divided into critical caloric defi cit (≥ 480 kcal/day) and non-critical caloric defi cit (≤ 480 kcal/day); and in critical protein defi cit (≥ 20 g/day) and non-critical protein defi cit (≤ 20 g/day). The fi ndings were correlated with hospital stay and mortality. Results: The mortality rate was 33%. Overall, the patients received 65.4% and 67.7% of the caloric and protein needs. Critical caloric defi cit was found in 72% of cases and critical protein defi cit in 70% of them. There was a signifi cant correlation between length of stay and accumulated caloric defi cit (R = 0.37; p < 0.001) and protein defi cit (R = 0.28; p < 0.001). The survival analysis showed that mortality was greater in patients with both critical caloric (p < 0.001) and critical protein defi cits (p < 0.01). The Cox regression analysis showed that critical protein defi cit was associated w...

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Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit*

Abstract: In the context of reducing risk of nosocomial bloodstream infections, failing to provide > or =25% of the recommended calories may be harmful. Higher caloric goals may be necessary to achieve other clinically important outcomes.

Cited by 338 publications

References 42 publications

Nutrition in the ICU: proof of the pudding is in the tasting

Nutrition in the ICU: proof of the pudding is in the tasting

Do Patients in the Intensive Care Unit Receive Recommended Total Daily Calories with Enteral Feedings Using a Rate Based Protocol?

Déficit crítico de energía y mortalidad en pacientes críticos

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