Medical nutrition therapy and clinical outcomes in critically ill adults: a European multinational, prospective observational cohort study (EuroPN)

Abstract

Background Medical nutrition therapy may be associated with clinical outcomes in critically ill patients with prolonged intensive care unit (ICU) stay. We wanted to assess nutrition practices in European intensive care units (ICU) and their importance for clinical outcomes. Methods Prospective multinational cohort study in patients staying in ICU ≥ 5 days with outcome recorded until day 90. Macronutrient intake from enteral and parenteral nutrition and non-nutritional sources during the first 15 days after ICU admission was compared with targets recommended by ESPEN guidelines. We modeled associations between three categories of daily calorie and protein intake (low: < 10 kcal/kg, < 0.8 g/kg; moderate: 10–20 kcal/kg, 0.8–1.2 g/kg, high: > 20 kcal/kg; > 1.2 g/kg) and the time-varying hazard rates of 90-day mortality or successful weaning from invasive mechanical ventilation (IMV). Results A total of 1172 patients with median [Q1;Q3] APACHE II score of 18.5 [13.0;26.0] were included, and 24% died within 90 days. Median length of ICU stay was 10.0 [7.0;16.0] days, and 74% of patients could be weaned from invasive mechanical ventilation. Patients reached on average 83% [59;107] and 65% [41;91] of ESPEN calorie and protein recommended targets, respectively. Whereas specific reasons for ICU admission (especially respiratory diseases requiring IMV) were associated with higher intakes (estimate 2.43 [95% CI: 1.60;3.25] for calorie intake, 0.14 [0.09;0.20] for protein intake), a lack of nutrition on the preceding day was associated with lower calorie and protein intakes (− 2.74 [− 3.28; − 2.21] and − 0.12 [− 0.15; − 0.09], respectively). Compared to a lower intake, a daily moderate intake was associated with higher probability of successful weaning (for calories: maximum HR 4.59 [95% CI: 1.5;14.09] on day 12; for protein: maximum HR 2.60 [1.09;6.23] on day 12), and with a lower hazard of death (for calories only: minimum HR 0.15, [0.05;0.39] on day 19). There was no evidence that a high calorie or protein intake was associated with further outcome improvements. Conclusions Calorie intake was mainly provided according to the targets recommended by the active ESPEN guideline, but protein intake was lower. In patients staying in ICU ≥ 5 days, early moderate daily calorie and protein intakes were associated with improved clinical outcomes. Trial registrationNCT04143503, registered on October 25, 2019. Graphical abstract

The Impact of Higher Protein Intake in Patients with Prolonged Mechanical Ventilation

“…The consensus was that the equivalent of 1.3 g/kg protein per day can be delivered progressively during critical illness [ 22 ]. In a recently published prospective multinational cohort study in critically ill patients with an ICU stay ≥5 days, a moderate daily macronutrient intake of 10–20 kcal/kg and a protein intake of 0.8–1.2 g/kg were associated with earlier weaning from invasive mechanical ventilation [ 23 ].…”

Association of fasting in the first 72 h of intensive care unit stay with outcomes of critically ill patients

“…In a recently published prospective observational cohort study (EuroPN), a moderate daily energy and protein intake were associated with improved clinical outcomes (higher probability of successful weaning and lower hazard of death) when compared with a lower intake 31 . However, this study evaluated nutrient intake during the first 15 days after ICU admission, in a period when organ dysfunctions are improving, and the inflammatory response is not so exacerbated (probably the period with the greatest benefit from nutrition support).…”

New features of parenteral nutrition in home care and acute care setting for the older population

“…Several concepts of parenteral nutrition use, which have become better defined in the past 2 years, are similar in both the geriatric and nongeriatric populations. These concepts include the notions that parenteral nutrition can be done more safely now with permissive underfeeding the acute setting, moderate glycaemic control, protein delivery at modest levels in the 1.3 g/kg/day or higher range, the use of intravenous lipid emulsions (IVLE), which offer a variety of lipid substrates, and meticulous management of central lines [4 Per oral (PO) intake versus the younger group [7]. An excellent ESPEN Guideline on clinical nutrition and hydration in Geriatrics has been published in 2022, which serves as an excellent practical guide [8 && ].…”