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, 18 (1), R29

Close to Recommended Caloric and Protein Intake by Enteral Nutrition Is Associated With Better Clinical Outcome of Critically Ill Septic Patients: Secondary Analysis of a Large International Nutrition Database

Close to Recommended Caloric and Protein Intake by Enteral Nutrition Is Associated With Better Clinical Outcome of Critically Ill Septic Patients: Secondary Analysis of a Large International Nutrition Database

Gunnar Elke et al. Crit Care.

Abstract

Introduction: Current international sepsis guidelines recommend low-dose enteral nutrition (EN) for the first week. This contradicts other nutrition guidelines for heterogenous groups of ICU patients. Data on the optimal dose of EN in septic patients are lacking. Our aim was to evaluate the effect of energy and protein amount given by EN on clinical outcomes in a large cohort of critically ill septic patients.

Methods: We conducted a secondary analysis of pooled data collected prospectively from international nutrition studies. Eligible patients had a diagnosis of sepsis and/or pneumonia and were admitted to the ICU for ≥3 days, mechanically ventilated within 48 hours of ICU admission and only receiving EN. Patients receiving parenteral nutrition were excluded. Data were collected from ICU admission up to a maximum of 12 days. Regression models were used to examine the impact of calorie and protein intake on 60-day mortality and ventilator-free days.

Results: Of the 13,630 patients included in the dataset, 2,270 met the study inclusion criteria. Patients received a mean amount of 1,057 kcal/d (14.5 kcal/kg/day) and 49 g protein/day (0.7 g/kg/d) by EN alone. Patients were mechanically ventilated for a median of 8.4 days and 60-day mortality was 30.5%. An increase of 1,000 kcal was associated with reduced 60-day mortality (odds ratio (OR) 0.61; 95% confidence interval (CI) 0.48 to 0.77, P <0.001) and more ventilator-free days (2.81 days, 95% CI 0.53 to 5.08, P = 0.02) as was an increase of 30 g protein per day (OR 0.76; 95% CI 0.65 to 0.87, P <0.001 and 1.92 days, 95% CI 0.58 to 3.27, P = 0.005, respectively).

Conclusions: In critically ill septic patients, a calorie and protein delivery closer to recommended amounts by EN in the early phase of ICU stay was associated with a more favorable outcome.

Figures

Figure 1
Figure 1
Flow chart of study population. Of 13,630 patients enrolled in the nutrition surveys and PEP uP trial between 2007 and 2011, 2,270 patients with pneumonia and sepsis from 351 ICUs were included in the final analysis. The 411 patients from the 2007 database were already included in a previous study [23]. EN, enteral nutrition; ICU, intensive care unit; INS, International Nutrition Survey; PN, parenteral nutrition.

Comment in

  • When More Is Better
    C Pichard. Crit Care 18 (2), 126. PMID 25029264.
    Nutrition support of critically ill patients with sepsis is one of the most debated issues among intensivists. The latest international sepsis guidelines recommend the pr …

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