Nutrition Therapy for the Critically Ill Surgical Patient
- 19 November 2010
- journal article
- research article
- Published by Wiley in Journal of Parenteral and Enteral Nutrition
- Vol. 34 (6), 644-652
- https://doi.org/10.1177/0148607110372391
Abstract
Background: To identify opportunities for quality improvement, the nutrition adequacy of critically ill surgical patients, in contrast to medical patients, is described. Methods: International, prospective, and observational studies conducted in 2007 and 2008 in 269 intensive care units (ICUs) were combined for purposes of this analysis. Sites provided institutional and patient characteristics and nutrition data from ICU admission to ICU discharge for maximum of 12 days. Medical and surgical patients staying in ICU at least 3 days were compared. Results: A total of 5497 mechanically ventilated adult patients were enrolled; 37.7% had surgical ICU admission diagnosis. Surgical patients were less likely to receive enteral nutrition (EN) (54.6% vs 77.8%) and more likely to receive parenteral nutrition (PN) (13.9% vs 4.4%) (P < .0001). Among patients initiating EN in ICU, surgical patients started EN 21.0 hours later on average (57.8 vs 36.8 hours, P < .0001). Consequently, surgical patients received less of their prescribed calories from EN (33.4% vs 49.6%, P < .0001) or from all nutrition sources (45.8% vs 56.1%, P < .0001). These differences remained after adjustment for patient and site characteristics. Patients undergoing cardiovascular and gastrointestinal surgery were more likely to use PN, were less likely to use EN, started EN later, and had lower total nutrition and EN adequacy rates compared with other surgical patients. Use of feeding and/or glycemic control protocols was associated with increased nutrition adequacy. Conclusions: Surgical patients receive less nutrition than medical patients. Cardiovascular and gastrointestinal surgery patients are at highest risk of iatrogenic malnutrition. Strategies to improve nutrition performance, including use of protocols, are needed.Keywords
This publication has 41 references indexed in Scilit:
- Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trialsBMJ, 2001
- Enteral compared with parenteral nutrition: a meta-analysisThe American Journal of Clinical Nutrition, 2001
- Should Immunonutrition Become Routine in Critically Ill Patients?JAMA, 2001
- Total Parenteral Nutrition in the Critically Ill PatientJAMA, 1998
- NUTRITIONAL SUPPORT IN THE CRITICALLY ILL PATIENTCritical Care Clinics, 1998
- Review: Bacterial Translocation and Enteral Nutrition in Humans: An Outsider Looks InJournal of Parenteral and Enteral Nutrition, 1995
- Early Enteral Feeding, Compared With Parenteral, Reduces Postoperative Septic Complications The Results of a Meta-AnalysisAnnals of Surgery, 1992
- Effects of Immediate Postoperative Enteral Nutrition on Body Composition, Muscle Function, and Wound HealingJournal of Parenteral and Enteral Nutrition, 1991
- Impaired Wound Healing in Surgical Patients with Varying Degrees of MalnutritionJournal of Parenteral and Enteral Nutrition, 1986
- Maintenance of GI Function after Bowel Surgery and Immediate Enteral Full Nutrition. I. Doubling of Canine Colorectal Anastomotic Bursting Pressure and Intestinal Wound Mature Collagen ContentJournal of Parenteral and Enteral Nutrition, 1980