Related Experiment Video
Updated: Jul 20, 2025
A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Nutritional support in the critical ill patient: Requirements, prescription and adherence
Camila Vergara1, Paulina Del Pozo2, Jessie Niklitschek1
1Departamento de Gastroenterología y Nutrición Pediátrica, División de Pediatría, Escuela de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile.
Insights
Critically ill children in the non-acute phase (nAP) showed high adherence to nutritional support, unlike those in the acute phase (AP). Overfeeding was common, particularly in the nAP, with feeding discontinuation being a key challenge.
Area of Science:
- Pediatric Critical Care Medicine
- Nutritional Support
- Clinical Nutrition
Background:
- Nutritional support for critically ill children presents challenges in requirement estimation and treatment adherence.
- Accurate assessment of energy and protein needs is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the relationship between nutritional requirements, prescription, and adherence in critically ill children.
- To analyze these associations based on the disease phase (acute vs. non-acute).
Main Methods:
- A prospective, observational study of 131 pediatric intensive/intermediate care patients (0-18 years).
- Data collected included demographics, anthropometrics, disease phase (AP/nAP), prescribed (P) and adhered (A) nutritional support, basal metabolic rate (BMR), and protein requirements (R).
- Calculated ratios: P/BMR, P/R, A/BMR, A/R, and A/P.
Main Results:
- Adherence to prescribed nutritional support was significantly higher in the non-acute phase (nAP) compared to the acute phase (AP).
- Overfeeding (energy and protein) was frequent, especially in the nAP.
- Feeding discontinuation occurred more often in the AP (53.8%) than in the nAP (26.3%).
Conclusions:
- Adherence to prescribed nutritional support is high in critically ill children during the non-acute phase.
- Overfeeding is a common issue, particularly in the non-acute phase.
- Discontinuation of nutritional support represents a significant barrier to adherence.
Introduction:
In critically ill patients, nutritional support is a challenge in terms of both estimating their requirements and ensuring adherence to the prescribed treatment.
Objective:
To assess the association between requirements, prescription and adherence to energy and protein supplementation based on the phase of disease in critically ill patients.
Sample And Methods:
We conducted a prospective, observational and analytical study in patients aged 0-18 years admitted to the paediatric intensive or intermediate care unit in 2020-2021. We collected data on demographic and anthropometric characteristics and the phase of disease (acute phase [AP] vs. non-acute phase [nAP]), in addition to prescribing (P) (indication of nutritional support), basal metabolic rate (BMR, Schofield equation), adherence to nutritional support (A) and protein requirements (R), and calculated the following ratios: P/BMR, P/R, A/BMR, A/R, and A/P.
Results:
The sample included 131 participants with a median age of 16 (4.5) months, of who 128 (97.7%) had comorbidities and 13 (9.9%) were in the AP. Comparing the phases of disease (AP vs. nAP), the median values for energy supplementation were P/BMR, 0.5 (IQR, 0.1-1.4) vs. 1.3 (IQR, 0.9-1.8) (P = 0.0054); A/BMR, 0.4 (IQR, 0-0.6) vs. 1.2 (IQR, 0.8-1.7) (P = 0.0005); A/P, 0.7 (IQR, 0-0.9) vs. 1 (IQR, 0.8-1) (P = 0.002), and for protein were P/R, 0.7 (IQR, 0-1.1) vs. 1.2 (0.9-1.6) (P = 0.0009); A/R 0.3 (IQR, 0-0.6) vs. 1.1 (IQR, 0.8-1.5) (P = 0.0002); A/P 0.7 (IQR, 0-1) vs. 1(IQR, 0.8-1) (P = 0.002). We found AP/nAP ratios greater than 110% for energy in the P/BMR (4 patients [30.8%]/72 patients [61%]; P = 0.007), A/BMR (3 [23%]/63 [53.4%]; P = 0.009) and A/P (1 [7%]/3 [2.5%]; P = 0.007). As for protein, more than 1.5 g/kg/day was prescribed in 3 patients (23.1%) in the AP and 71 (60.1%) in the nAP. We found adherence to the prescribed intake in 2 (15.4%) patients in the AP and 66 (56%) in the nAP. We found a correlation coefficient of 0.6 between the energy P/R and the protein P/R. Prescribed support was discontinued in 7 patients (53.8%) in the AP and 31 (26.3%) in the nAP (P = 0.002).
Conclusions:
The proportion of adherence to prescribed nutritional support was high in patients in the nAP of the disease. Overfeeding was frequent, more so in the nAP. We identified difficulties in adhering to prescribed support, chief of which was the discontinuation of feeding.
Related Concept Videos
01:28Chronic Kidney Disease III: Interprofessional Care
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
01:25Peritoneal Dialysis III: Nursing Management
01:18Chronic Kidney Disease IV: Nursing Management