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ISSN 2448-8909 (Print)

2009, Number 2

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Med Crit 2009; 23 (2)

Impact of delayed initiation of nutritional support of morbidity and mortality in the Intensive Care Unit

Chávez-Pérez JP, Sánchez-Velázquez LD

Language: Spanish
References: 31
Page: 70-75
PDF size: 87.86 Kb.


ABSTRACT

Background: Malnutrition in critically ill patients (confirmed by a negative caloric balance), has been associated with higher mortality. Objectives: To determine the impact that has delayed start of nutritional support on morbi-mortality of patients in ICUs participating in the study.
Design: Prospective cohort in 12 ICUs of different public and private hospitals in Mexico City.
Subjects: 4,494 were included, 1,702 of them were disqualified due to incomplete information.
Methods: Demographic, APACHE II, Brussels and NEMS were collected. The population under study was divided in two groups: Group A start nutrition before 36 hours of their arrive at ICUs. Group B start nutrition after 36 hours of their arrive at ICUs. The statistical analysis consisted of bivariate and mutivariate analysis, considering significant a p ‹ 0.05.
Results: Statistically significant differences were observed in stay, co-morbidity acquired in ICUs and use of resources, in relationship to delayed in start nutrition. In the multivariate analysis was observed that delay in start nutrition for more than 36 hours, has a risk 1.6 times higher of mortality.
Conclusions: Delayed start nutrition support is associated with longer hospital stay, higher co-morbidity acquired in ICUs, higher consumption of resources and mortality.


REFERENCES

  1. Vasken A, DiGiovine B. The effects of early enteral feeding on the clinical outcomes of critically ill patients. Chest 2003; 124: 175S.

  2. Barton RG. Nutrition support in critical illness. Nutr Clin Pract 1994; 9: 127-139.

  3. Wojnar MM, William WG, Lang CH. Nutritional support of the septic patient. Crit Care Clin 1995; 3: 717-733.

  4. Windsor JA, Hill GL. Risk factors for postoperative pneumonia. The importance of protein depletion. Ann Surg 1988; 208: 209-214.

  5. Hermann FR, Safran C, Levkoff SE. Serum albumin level on admission as a predictor of death, length of stay, and readmission. Arch Intern Med 1992; 152: 125-130.

  6. Cerra FB. Hypermetabolism. Organ failure and metabolic support. Surgery 1987; 101: 1.

  7. Cunningham JJ. Factors contributing to increased energy expenditure in thermal injury: A review of studies employing indirect calorimetry. J Parenter Enter Nutr 1990; 14: 649-656.

  8. Chan S, McCoven KC, Blackburn GL. Nutrition management in the ICU. Chest 199; 115: 145S-148S.

  9. Baue AE. Nutrition and metabolism in sepsis and multisystem organ failure. Surg Clin North Am 1991; 71: 549-563.

  10. Lafrance JP, Leblanc M. Metabolic, electrolytes, and nutritional concerns in critical illness. Crit Care Clin 2005; 21: 305-327.

  11. Flancbaum L, Choban PS, Sambucco S, Verducci J, Burge JC. Comparison of indirect calorimetry, the Fick method, and predictive equations in estimating the energy requirements of critically ill patients. Am J Clin Nutr 69.: 461-466.

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

  13. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ 1994; 308: 945-948.

  14. Cerra FB, Benitez MR, Blackburn GL. Applied nutrition in ICU patients: A consensus statement of the American College of Chest Physicians. Chest 1997; 111: 769-778.

  15. Mault J. ICU Nutritional Study Group. Energy balance and outcome in critically ill patients: results of a multicenter, prospective, randomized trial (abstract). Scientific Abstracts 2000: 35

  16. Heyland D, Cook DJ, Winder B. Enteral nutrition in the critically ill patient: A prospective survey. Crit Care Med 1995; 23: 1055-1066.

  17. McClave SS, Sexton LK, Spain DS. Enteral tube feeding in the intensive care unit: Factors impeding adequate delivery. Crit Care Med 1999; 27: 1252-1256.

  18. Zaloga CP. Timing and route of nutritional support. Nutrition and critical care: Nestlé Nutrition Workshop Series Clinical and Performance Program. Basel Switzerland: Karger, 1994: 297-330.

  19. Roberts RP, Zaloga CP. Enteral nutrition in the critically ill patient. In: Grenvick A, Ayres SM, Hollbrook PR. eds. Textbook of critical care. 4th. ed. Philadelphia, P.A.: W.B. Saunders, 2000: 875-898.

  20. Muskat PC. The benefits of early enteral nutrition. In: Shikora SS, Blackburn GL, eds. Nutrition support: Theory and therapeutics. New York N.Y.: Chapman and Hall 1997: 231-241.

  21. Quigley EM, Marsh MN, Shaffer JL. Hepatobiliary complications of total parenteral nutrition. Gastroenterology 1993; 104: 286-301.

  22. Moore FA, Feliciano DV, Andrassy RJ. Early enteral feeding, compared with parenteral, reduces postoperative septic complications: the results of meta-analysis. Ann Surg 1992; 216: 172-183.

  23. Marik PE, Zaloga CP. Early enteral nutrition in acutely ill patients: A systematic review. Crit Care Med 2001; 29: 2264-2270.

  24. Babineau TJ, Blackburn GL. Time to consider early gut feeding. Crit Care Med 1994; 22: 191-193.

  25. Minard G, Kudsk KA. Is early feeding beneficial? How early is early. New Horiz 1994; 2: 156-163.

  26. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enteral Nutr 2002; 26S: 1SA-138SA.

  27. Lewis SJ, Egger M, Sylvester PA. Early enteral feeding versus «nil by mouth» after gastrointestinal surgery: Systematic review and meta-analysis of controlled trials. BMJ 2001; 323: 1-5.

  28. Neumayer LA, Smout RJ, Horn HG. Early and sufficient feeding reduces length of stay and charges in surgical patients. J Surg Res 2001; 95: 73-77.

  29. Braga M, Gianotti L, Vignali A, Cestari A, Bisagni P, Di Carlo V. Artificial nutrition alters major abdominal surgery: Impact of route of administration and composition of the diet. Crit Care Med 1998; 26: 24-30.

  30. Zaloga GP. Early enteral nutritional support improves outcome: Hypothesis or fact? Crit Care Med 1999; 27: 259-261.

  31. Barlett RH, Dechert RE, Mault, JR, Ferguson SK, Kaiser AM, Erlanson EE. Measurement of metabolism in multiple organ failure. Surgery 1982; 10: 771-779.




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