Factors affecting the caloric and protein intake over time in critically ill trauma patients

J Surg Res. 2018 Jun;226:64-71. doi: 10.1016/j.jss.2018.01.022. Epub 2018 Feb 10.

Abstract

Background: Major trauma leads to increased nutritional requirements. However, little is known about the actual amount of calories and protein administered and the factors affecting the intake over time in critically ill trauma patients.

Methods: Prospective study including 100 trauma patients admitted to the Los Angeles County + University of Southern California Medical Center intensive care unit between March 2014 and October 2014. Inclusion criteria were age > 16 y, surgery at admission, and no oral nutrition. The caloric and protein intake was recorded, and requirements were calculated daily for 28 d. The nutritional intake and the impact of clinical factors on the intake over time were assessed using mixed model analysis.

Results: The caloric and protein intake significantly increased over time, but the median intake did not meet the median calculated requirements at any time. Multivariable analysis revealed a smaller increase of the nutritional intake over time in patients with an injury severity score > 45, whereas penetrating injury and laparotomy were associated with a higher increase of the intake. Body mass index scores ≥ 30 kg/m2, traumatic brain injury, and gastrointestinal tract injuries were associated with a smaller increase of the caloric intake over time.

Conclusions: The median nutritional intake did not meet the median calculated requirements over time. A smaller increase of the nutritional intake over time was found in patients with a higher injury burden, whereas penetrating injury and laparotomy were associated with a higher increase of the intake. Higher body mass index scores, traumatic brain injury, and gastrointestinal tract injuries were associated with a smaller increase of the caloric intake over time. These clinical factors can help to adjust the nutritional support in critically ill trauma patients.

Keywords: Caloric requirements; Critical illness; Multiple trauma; Nutritional support; Prospective study; Protein requirements.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Body Mass Index
  • California
  • Critical Illness / therapy*
  • Dietary Proteins / administration & dosage*
  • Energy Intake*
  • Enteral Nutrition / statistics & numerical data*
  • Female
  • Humans
  • Injury Severity Score
  • Intensive Care Units / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Nutritional Status
  • Prospective Studies
  • Wounds and Injuries / diagnosis
  • Wounds and Injuries / diet therapy*
  • Wounds and Injuries / surgery
  • Young Adult

Substances

  • Dietary Proteins