Current clinical nutrition practices in critically ill patients in Latin America: a multinational observational study.

Autor: Vallejo KP; Intensive Care and Nutrition Unit, Hospital Clínico de la Universidad de Chile, Santiago de Chile, Chile., Martínez CM; Universidad Militar Nueva Granada, Bogotá, Colombia., Matos Adames AA; Complejo Hospitalario de la Caja del Seguro Social de Panamá, Panama City, Panama., Fuchs-Tarlovsky V; Hospital General de México, Mexico City, Mexico., Nogales GCC; Hospital Guillermo Kaelin de la Fuente, Villa María del Triunfo, Peru., Paz RER; Hospital Metropolitano, Quito, Ecuador., Perman MI; Adult Intensive Care Unit, Department of Medicine, Italian Hospital of Buenos Aires, Buenos Aires, Argentina., Correia MITD; Universidade Federal de Minas Gerais Medical School, Av. Carandaí 246 Apt. 902, Belo Horizonte, 30130-060, Brazil. isabel_correia@uol.com.br., Waitzberg DL; Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2017 Aug 25; Vol. 21 (1), pp. 227. Date of Electronic Publication: 2017 Aug 25.
DOI: 10.1186/s13054-017-1805-z
Abstrakt: Background: Malnutrition in critically ill adults in the intensive care unit (ICU) is associated with a significantly elevated risk of mortality. Adequate nutrition therapy is crucial to optimise outcomes. Currently, there is a paucity of such data in Latin America. Our aims were to characterise current clinical nutrition practices in the ICU setting in Latin America and evaluate whether current practices meet caloric and protein requirements in critically ill patients receiving nutrition therapy.
Methods: We conducted a cross-sectional, retrospective, observational study in eight Latin American countries (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Panama, and Peru). Eligible patients were critically ill adults hospitalised in the ICU and receiving enteral nutrition (EN) and/or parenteral nutrition (PN) on the Screening Day and the previous day (day -1). Caloric and protein balance on day -1, nutritional status, and prescribed nutrition therapy were recorded. Multivariable logistic regression analysis was performed to identify independent predictors of reaching daily caloric and protein targets.
Results: The analysis included 1053 patients from 116 hospitals. Evaluation of nutritional status showed that 74.1% of patients had suspected/moderate or severe malnutrition according to the Subjective Global Assessment. Prescribed nutrition therapy included EN alone (79.9%), PN alone (9.4%), and EN + PN (10.7%). Caloric intake met >90% of the daily target in 59.7% of patients on day -1; a caloric deficit was present in 40.3%, with a mean (±SD) daily caloric deficit of -688.8 ± 455.2 kcal. Multivariable logistic regression analysis showed that combined administration of EN + PN was associated with a statistically significant increase in the probability of meeting >90% of daily caloric and protein targets compared with EN alone (odds ratio, 1.56; 95% confidence interval, 1.02-2.39; p = 0.038).
Conclusions: In the ICU setting in Latin America, malnutrition was highly prevalent and caloric intake failed to meet targeted energy delivery in 40% of critically ill adults receiving nutrition therapy. Supplemental administration of PN was associated with improved energy and protein delivery; however, PN use was low. Collectively, these findings suggest an opportunity for more effective utilisation of supplemental PN in critically ill adults who fail to receive adequate nutrition from EN alone.
Databáze: MEDLINE
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