Intensive Medical Nutrition Therapy: Methods to Improve Nutrition Provision in the Critical Care Setting

• Published in: Journal of the Academy of Nutrition and Dietetics 2012-07, Vol.112 (7), p.1073-1079
• Main Authors: Sheean, Patricia M., PhD, RD, Peterson, Sarah J., MS, RD, Zhao, Weihan, MS, Gurka, David P., MD, Braunschweig, Carol A., PhD, RD
• Format: Article
• Language: English
• Subjects: administration & dosage; adverse effects; APACHE; Biological and medical sciences; body weight; Cohort Studies; confidence interval; Critical Care; Critical Care - methods; Critical Illness; Critical Illness - mortality; Critical Illness - therapy; Dietary Proteins; Dietary Proteins - administration & dosage; Diseases of the digestive system; energy; Energy Intake; enteral feeding; Enteral Nutrition; Enteral Nutrition - methods; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; gastrointestinal system; hemorrhage; Humans; Internal Medicine; intestinal obstruction; Length of Stay; Male; malnutrition; Medical sciences; methods; Middle Aged; mortality; Nutrition Therapy; Nutrition Therapy - methods; Nutritional Status; patients; Proportional Hazards Models; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Respiration, Artificial; Respiration, Artificial - adverse effects; therapy; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 2212-2672; 2212-2680
• DOI: 10.1016/j.jand.2012.02.007

Abstract Patients requiring mechanical ventilation in an intensive care unit commonly fail to attain enteral nutrition (EN) infusion goals. We conducted a cohort study to quantify and compare the percentage of energy and protein received between standard care (n=24) and intensive medical nutrition therapy (MNT) (n=25) participants; to assess the percentage of energy and protein received varied by nutritional status, and to identify barriers to EN provision. Intensive MNT entailed providing energy at 150% of estimated needs, using only 2.0 kcal/cc enteral formula and 24-hour infusions. Estimated energy and protein needs were calculated using 30 kcal/kg and 1.2 g protein/kg actual or obesity-adjusted admission body weight. Subjective global assessment was completed to ascertain admission intensive care unit nutritional status. Descriptive statistics and survival analyses were conducted to examine time until attaining 100% of feeding targets. Patients had similar estimated energy and protein needs, and 51% were admitted with both respiratory failure and classified as normally nourished (n=25/49). Intensive MNT recipients achieved a greater percentage of daily estimated energy and protein needs than standard care recipients (1,198±493 vs 475±480 kcal, respectively, P