Gülseren ELAY, Cevdet YARDIMCI, Kürşat GÜNDOĞAN

Retrospective Evaluation of Unstable Patients Fed Parenterally in Intensive Care Unit: Single Center Experience

The aim of this study was to determine the demographic and clinical characteristics of patients fed with total parenteral nutrition who were hemodynamically unstable in the ICU. This study was performed retrospectively in the medical intensive care unit of a university hospital. Information was obtained from the patients’ files, the hospital electronic registry system and nutrition unit registration forms. This study included 51 patients. The mean age of the patients was 57 ± 19 years, of the patients 47% were male and 53% were female. When the reasons for total parenteral nutrition were evaluated, it was found that the most common causes of total parenteral nutrition were because of septic shock (47%) and gastrointestinal bleeding (23%). The daily caloric intake of the patients was 1,389 ± 286 kcal, and the target caloric value was 1,824 ± 256. The number of days with mechanical ventilation was 5 (median 0–42), the number of days stayed in the intensive care unit was 9 (median 1–125) and the number of days stayed in the hospital was 13 (median 1–155). The mortality rate of the patients was 71%. Serum albumin levels were found to be lower in patients who died than in those who lived, and these low albumin levels were statistically significant (p=0.015). In this study, it was seen that total parenteral nutrition was most commonly applied to the patients in a state of septic shock who had vasopressor support and to the patients who had gastrointestinal bleeding. In addition, it was determined that the target energy value could not be reached.

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1. Korfali G, Gundogdu H, Aydintug S, Bahar M, Besler T, Moral AR, et al. Nutritional risk of hospitalized patients in Turkey. Clinical nutrition (Edinburgh, Scotland) 2009; 28: 533-537.

2. Shpata V, Prendushi X, Kreka M, Kola I, Kurti F, Ohri I. Malnutrition at the time of surgery affects negatively the clinical outcome of critically ill patients with gastrointestinal cancer. Medical archives (Sarajevo, Bosnia and Herzegovina) 2014; 68: 263-267.

3. Fatemeh Osooli, Saeed Abbas, Shadi Farsaei, Payman Adibi. Identifying Critically Ill Patients at Risk of Malnutrition and Underfeeding: A Prospective Study at an Academic Hospital. Adv Pharm Bull 2019; 9: 314-320.

4. Paolo Cotogni. Management of parenteral nutrition in critically ill patients. World Journal of Critical Care Medicine 2017; 6: 13-20.

5. Annika Reintam Blaser, Joel Starkopf, Waleed Alhazzani, Mette M. Berger, Michael P. Casaer. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017; 43: 380-398.

6. Didace Ndahimana, Eun-Kyung Kim. Energy Requirements in Critically Ill Patients. Clin Nutr Res 2018; 7: 81-90.

7. De Jonghe B, Appere-De-Vechi C, Fournier M, et al. A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Critical care medicine 2001; 29: 8-12.

8. O’Meara D, Mireles-Cabodevila E, Frame F, et al. Evaluation of delivery of enteral nutrition in critically ill patients receiving mechanical ventilation. American Journal of Critical Care 2008; 17: 53-61.

9. Rice TW, Swope T, Bozeman S, Wheeler AP. Variation in enteral nutrition delivery in mechanically ventilated patients. Nutrition (Burbank, Los Angeles County, Calif) 2005; 21: 786-792.

10. Doig GS, Simpson F, Delaney A. A review of the true methodological quality of nutritional support trials conducted in the critically ill: time for improvement. Anesthesia and analgesia 2005; 100: 527-533.

11. McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Journal of Parenteral and Enteral Nutrition 2009; 33: 277-316.

12. Stephen A. McClave, Mohamed A. Saad, Mark Esterle, Mary Anderson, Alice E. Jotautas. Volume-Based Feeding in the Critically Ill Patient. Journal of Parenteral and Enteral Nutrition 2015; 39: 707-712.

13. Brouwers M, Stacey D, O’Connor A. Knowledge creation: synthesis, tools and products. Canadian Medical Association Journal 2010; 182: 68-72.

14. Cahill NE, Dhaliwal R, Day AG, Jiang X, Heyland DK. Nutrition therapy in the critical care setting: What is “best achievable” practice? An international multicenter observational study*. Critical care medicine 2010; 38: 395-401.

15. McClave SA, Chang W-K. Feeding the hypotensive patient: does enteral feeding precipitate or protect against ischemic bowel? Nutrition in clinical practice 2003; 18: 279-284.

16. Andus T. ESPEN guidelines on enteral nutrition: liver disease - tube feeding (TF) in patients with esophageal varices is not proven to be safe. Clinical nutrition (Edinburgh, Scotland) 2007; 26: 272; author reply 3-4.

17. Dhaliwal R, Cahill N, Lemieux M, Heyland DK. The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2014; 29: 29-43.

18. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Critical care medicine 2013; 41: 580-637.

19. Stefan Ludewig, Rami Jarbouh, Michael Ardelt, Henning Mothes, Falk Rauchfuß. Bowel Ischemia in ICU Patients: Diagnostic Value of I-FABP Depends on the Interval to the Triggering Event. Hindawi Gastroenterology Research and Practice. 2017. DOI:10.1155-2017-2795176

20. Daisuke Kurita, Takeo Fujita, Yasumasa Horikiri, Takuji Sato, Hisashi Fujiwara. Non-occlusive mesenteric ischemia associated with enteral feeding after esophagectomy for esophageal cancer: report of two cases and review of the literature. Kurita et al. Surgical Case Reports (2019) 5:36 DOI:10.1186-s40792-019-0580-2.

21. Bradbury AW, Brittenden J, McBride K, Ruckley CV. Mesenteric ischaemia: a multidisciplinary approach. The British journal of surgery 1995; 82: 1446-1459.

22. Lawlor DK, Inculet RI, Malthaner RA. Smallbowel necrosis associated with jejunal tube feeding. Canadian journal of surgery Journal canadien de chirurgie 1998; 41: 459-462.

23. Park WM, Gloviczki P, Cherry KJ, Jet al. Contemporary management of acute mesenteric ischemia: Factors associated with survival. Journal of vascular surgery 2002; 35: 445-452.

24. Zaloga GP, Roberts PR, Marik P. Feeding the hemodynamically unstable patient: a critical evaluation of the evidence. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2003; 18: 285-293.

25. Paul Wischmeyer. Nutrition therapy ın sepsıs. Crit Care Clin 2018; 34: 107-125.

26. Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. American journal of critical care : an official publication, American Association of Critical-Care Nurses 2010; 19: 261-268.

27. McClave SA, Chang WK. When to feed the patient with gastrointestinal bleeding. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2005; 20: 544-550.

28. de Ledinghen V, Beau P, Mannant PR, et al. Early feeding or enteral nutrition in patients with cirrhosis after bleeding from esophageal varices? A randomized controlled study. Digestive diseases and sciences 1997; 42: 536-541.

29. Barr J, Hecht M, Flavin KE, Khorana A, Gould MK. Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest 2004; 125: 1446-1457.

30. Woodcock NP, Zeigler D, Palmer MD, Buckley P, Mitchell CJ, MacFie J. Enteral versus parenteral nutrition: a pragmatic study. Nutrition (Burbank, Los Angeles County, Calif) 2001; 17: 1-12.