An Assessment of Nutritional Support to Critically Ill Patients and Its Correlation With Outcomes in a Respiratory Intensive Care Unit

BACKGROUND: Nutritional support is frequently neglected in a busy intensive care unit (ICU) with overworked staff. There is a paucity of investigations on ICU nutrition from India.

OBJECTIVES: To assess the adequacy of nutritional support administered to patients requiring mechanical ventilation in the respiratory ICU of a tertiary-care institute, and its correlation with outcomes.

METHODS: This was a prospective cohort study of patients ≥ 15 years old who underwent mechanical ventilation for at least 24 hours and had a respiratory ICU stay of at least 48 hours. Enteral nutritional support was initiated as early as possible after respiratory ICU admission. The daily calorie and protein prescription was 30 kcal/kg and 1.2 g/kg ideal body weight, respectively, with appropriate adjustments for critical illness(es) and comorbidities. Anthropometric and laboratory parameters were assessed serially. Risk factors for hospital mortality were evaluated using multivariable logistic regression analysis.

RESULTS: During the study period, 258 patients were admitted to the respiratory ICU, of whom 93, who fulfilled all the inclusion criteria, composed the study population. Calorie prescription increased from a median and interquartile range (IQR) of 88.9% (80.4-99.0%) of the recommended value on day 1 to 114.4% (99.9-122.5%) on day 21. Protein prescription improved from 80.1% (67.1-90.6%) of the recommended value on day 1 to 98.4% (76.1-120.8%) on day 28. Calorie delivery increased from 55.1% (35.4-81.3%) of the recommended value on day 1 to 92.0% (35.7-124.6%) on day 28. Protein delivery improved from 46.7% (31.6-72.1%) of the recommended value on day 1 to 75.3% (54.3-85.5%) on day 28. Risk factors for hospital mortality identified were admission Sequential Organ-Failure Assessment score (odds ratio 1.30, 95% confidence interval 1.03-1.63) and mean daily calorie delivery of ≤ 50% of the recommended value (odds ratio 12.08, 95% confidence interval 1.40-104.11).

CONCLUSIONS: Calorie and protein delivery to critically ill patients remains less than the recommended values. Inadequate calorie delivery is associated with higher odds of mortality.