Nutritional Adequacy in Mechanically Ventilated Patient: Are We Doing Enough?

Area of Science:

• Critical care medicine
• Clinical nutrition
• Intensive care unit (ICU) management

Background:

• Critically ill patients experience stress, leading to a catabolic state and increased energy needs.
• Malnutrition in these patients is linked to adverse clinical outcomes.
• Mechanical ventilation (MV) is a common intervention in critical care, often necessitating nutritional support.

Purpose of the Study:

• To evaluate the nutritional adequacy, defined as receiving >80% of prescribed calories, in mechanically ventilated (MV) patients.
• To determine the impact of nutritional adequacy on patient outcomes, including ventilator days and ICU length of stay (LOS).
• To identify the primary reasons for deviations from prescribed enteral nutrition (EN) regimens in MV patients.

Main Methods:

• A prospective observational study was conducted on adult critically ill patients requiring MV for over 48 hours.
• Patients received enteral nutrition (EN) with a target of 25 kcal/kg (IBW) and 1.2 g/kg protein daily.
• Data collected included patient demographics, nutritional risk scores (mNUTRIC), EN delivery, prescribed vs. achieved intake, and reasons for interruptions or delays.

Main Results:

• Out of 622 MV patients, 36.1% were at nutritional risk. Only 29.6% achieved nutritional adequacy (>80% of prescribed calories).
• Patients received an average of 63% of prescribed calories and 57% of prescribed proteins.
• Common reasons for inadequate nutrition included airway procedures (68.2%) and gastrointestinal intolerance (15%).

Conclusions:

• A significant disparity exists between prescribed and delivered nutrition in mechanically ventilated patients, even with adherence to guidelines.
• Nutritional inadequacy was not found to impact clinical outcomes in this cohort.
• Further research may be needed to optimize nutritional delivery strategies in critical care settings.