Assessment of nutritional support in critically ill patients and its correlation with outcomes at respiratory intensive care unit at Zagazig University Hospitals in (2014–2015)

Abstract

Background: Adequate nutritional support is essential for improving outcomes in hospitalized critically ill patients, who have high rates of malnutrition. Critical illness is typically associated with a catabolic stress state in which patients commonly demonstrate a systemic inflammatory response. This response is coupled with complications. So, malnutrition and inappropriate nutritional support lead to increased morbidity and mortality, decreased quality of life, prolonged duration of mechanical ventilation, and increased length of hospital stay. Critically ill patients require special attention to prevent muscle wasting and to avoid a lot of complications. Aim of the study: To throw light on nutritional assessment in critically ill patients and the effect of providing appropriate nutritional support in respiratory ICU based on patients, clinical condition on their outcome. Patients and methods: A non-randomized clinical trial was carried out at Respiratory Intensive Care Unit at Zagazig University Hospitals during the study period (2014–2015). This study was conducted on 96 patients who were admitted to RICU. They were categorized into 3 groups according to nutritional support. Group (1): 32 patients supported by enteral nutrition (EN). Group (2): 32Patients with inadequate enteral nutrition and supported by complementary parenteral nutrition (Compl. PN) Group (3): 32 patients supported by total parenteral nutrition (TPN) as EN was contraindicated for them. All patients were subjected to full history taking, clinical examination, and nutritional assessment through dietary and fluid intake history, clinical assessment, biochemistry and anthropometry. The nutrition regimen was designed after assessing the patient requirements for energy, protein, fluid and electrolytes. Monitoring of patients was done by follow up of the anthropometry and laboratory parameters, finally, the outcome variables were compared between the 3 groups. Results: Of the 3 studied groups, there were no differences in their daily caloric and protein requirements but the percentage of goal delivered was higher in Compl. PN and TPN groups than in the EN group (100% vs 81.41% ± 13.45%). EN group patients have better nitrogen balance than in the Compl. PN and TPN groups (p 0.02, <0.001 respectively) at follow up days. Pneumonia, sepsis and infections other than pneumonia were higher in the TPN group but vomiting and diarrhea were higher in the EN group and metabolic complications were higher in the TPN group as regardsthe duration of MV and the length of hospital stay both were higher in TPN group than in the other two groups, difficult and prolonged weaning were higher in the TPN group. Mortality was higher in the TPN group (p < 0.01). Conclusion: Sufficient nutritional support whether enteral or parenteral is very important in critically ill patients. TPN should never be used as a substitute for EN in patients who can tolerate enteral feeding as it is associated with infectious and metabolic complications and its deleterious effect on patients, outcome.

Keywords

• Enteral nutrition
• Total parenteral nutrition
• RICU
• Nutritional assessment
• Nutritional support