Enteral nutrition management in critically ill adult patients and its relationship with intensive care unit-acquired muscle weakness: A national cohort study.

Autor: Zaragoza-García I; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.; Invecuid, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain., Arias-Rivera S; University Hospital of Getafe, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Getafe, Spain., Frade-Mera MJ; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.; Department of Critical Care, 12 Octubre University Hospital, Madrid, Spain., Martí JD; Clinic University Hospital, Barcelona, Spain., Gallart E; Department of Critical Care, Vall Hebron University Hospital, Barcelona, Spain., San José-Arribas A; Escola Universitaria d'Infermeria Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Velasco-Sanz TR; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.; Department of Critical Care, San Carlos University Hospital, Madrid, Spain., Blazquez-Martínez E; Bellvitge University Hospital, Hospitalet de Llobregat, Llobregat, Spain., Raurell-Torredà M; Department d'Infermeria Fonamental i medicoquirúrgica, Facultat d'Infermeria, Universitat de Barcelona, Barcelona, Spain.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Jun 07; Vol. 18 (6), pp. e0286598. Date of Electronic Publication: 2023 Jun 07 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0286598
Abstrakt: Objective: To assess the incidence and determinants of ICU-acquired muscle weakness (ICUAW) in adult patients with enteral nutrition (EN) during the first 7 days in the ICU and mechanical ventilation for at least 48 hours.
Methods: A prospective, nationwide, multicentre cohort study in a national ICU network of 80 ICUs. ICU patients receiving invasive mechanical ventilation for at least 48 hours and EN the first 7 days of their ICU stay were included. The primary outcome was incidence of ICUAW. The secondary outcome was analysed, during days 3-7 of ICU stay, the relationship between demographic and clinical data to contribute to the onset of ICUAW, identify whether energy and protein intake can contribute independently to the onset of ICUAW and degree of compliance guidelines for EN.
Results: 319 patients were studied from 69 ICUs in our country. The incidence of ICUAW was 153/222 (68.9%; 95% CI [62.5%-74.7%]). Patients without ICUAW showed higher levels of active mobility (p = 0.018). The logistic regression analysis showed no effect on energy or protein intake on the onset of ICUAW. Overfeeding was observed on a significant proportion of patient-days, while more overfeeding (as per US guidelines) was found among patients with obesity than those without (42.9% vs 12.5%; p<0.001). Protein intake was deficient (as per US/European guidelines) during ICU days 3-7.
Conclusions: The incidence of ICUAW was high in this patient cohort. Early mobility was associated with a lower incidence of ICUAW. Significant overfeeding and deficient protein intake were observed. However, energy and protein intake alone were insufficient to explain ICUAW onset.
Relevance to Clinical Practice: Low mobility, high incidence of ICUAW and low protein intake suggest the need to train, update and involve ICU professionals in nutritional care and the need for early mobilization of ICU patients.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Zaragoza-García et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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