Nutritional support in critically ill patients

Introduction

Early adequate nutritional support (NS) in critically ill patients can improve clinical outcome [1]. Although enteral nutrition is considered the best method, it carries a risk for developing ventilator-associated pneumonia, particularly if patients are nursed horizontally [1]. The aim of this prospective audit is to assess the compliance of nutritional practise in our ICU with some aspects of recommendations of Canadian Clinical Guidelines.

Method

Demographic data, head elevation (HE) from the horizontal position, daily nitrogen and calorie intake were recorded. Daily recommended calorie requirements were calculated according to body weights on admission. The nasogastric tube size and the gastric residual volume threshold (GRVT) before abandoning enteral feeds were also recorded.

Results

During 2 months 55 patients (male 47%, female 53%) were admitted, including 47 (85%) emergency admissions. Thirty-three (60%) patients stayed in the unit for >48 hours with an average stay of 7.1 days. Thirty-two (58%) patients received NS, and 26 (81%) of these were within 48 hours of admission. Enteral and parenteral routes were used in 26 (81%) and six (18%) patients, respectively. In five (15%) patients both methods were used during the change of route of administration. The daily calorie intake expressed as a percentage of the recommended intake is presented in Table 1. HE was more than 300 in 70% of the 570 measurements. Blood sugar was between 6.3 and 6.9 mmol/l. Gastro Prokinetics was used in 80%. There was no feeding protocol in the unit and low GRVTs were used before abandonment of the enteral regime.

Table 1 (abstract P145)

Conclusion

We found that there was overfeeding in the parenteral and combined routes. HE was satisfactory in 70% and more patients could receive enteral feeds if a high GRVT was used. Small-bore tubes are easy to implement and were not practised.