Higher Energy and Protein Intake from Enteral Nutrition May Reduce Hospital Mortality in Mechanically Ventilated Critically Ill Elderly Patients

Abstract

Summary: Background: The objective of this study was to investigate whether the nutrition intake from enteral nutrition (EN) and parenteral nutrition (PN) created a better clinical outcome than EN alone in high nutritional risk (HNR) mechanically ventilated critically ill elderly patients. Methods: We included patients ≥ 65 years on mechanical ventilation ≥ 48 h and received EN. Nutritional status was evaluated by Modify NUTrition Risk in Critical ill score (mNUTRIC). We calculated the energy and protein requirements as Harris-Benedict equation × 1.0–1.3 and 1.0–2.0 gm/kg body weight respectively. Nutrition intake from EN and PN was recorded within 7 days. ICU and hospital mortalities in HNR elderly patients who could achieve more or less 80% prescribed nutrition were compared. Result: Among 190 critically ill elderly patients, 173 (91.1%) HNR patients had mNUTRIC ≥ 5. HNR patients who achieved ≥80% prescribed calorie had lower ICU mortality (13.5% vs 25.8%; P = 0.04) and hospital mortality (23.4% vs 40.3%; P = 0.02) compared to those who achieved <80% prescription. For those who EN protein achieved ≥80% prescription had a lower hospital mortality (23.4% vs 40.3%; P = 0.02). For each point increase of mNUTRIC, ICU length of stay (LOS) increased 1.18 days, Days of Mechanical Ventilation (MVDs) increased 1.54 days, hospital LOS increased 1.52 days, the ICU mortality OR = 1.71 (1.22–2.39) and hospital mortality OR = 1.64 (1.24–2.15). Conclusion: Very high percentage (91.1%) of medical intensive care (MICU) elderly patients were in HNR. Those who EN calorie achieved ≥80% prescription had lower ICU and hospital mortality. Increased EN protein intake only lowered hospital mortality. Keywords: critically ill elderly, hospital mortality, ICU length of stay, ICU mortality, mNUTRIC score