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Pilot Study to Investigate Enteral Feeding Practices and the Incidence of Underfeeding Amongst Mechanically Ventilated Critically Ill Patients at Specialist Tertiary Care Hospital in Saudi Arabia.
JPEN. Journal of Parenteral and Enteral Nutrition 2020 September 15
BACKGROUND: Enteral-nutrition (EN) is an essential therapeutic intervention. Many studies internationally have reviewed the feeding practices in intensive-care units (ICU) and recorded the incidence of underfeeding in these settings, yet none were performed in the Middle-East including Saudi-Arabia. The purpose of the study is to assess the adequacy of EN delivery and to investigate the enteral-feeding practices in ICU at a specialised tertiary-care hospital in Saudi-Arabia.
METHODOLOGY: In this observational study we prospectively monitored energy and protein delivery for 6 consecutive days in critically-ill patients. Malnutrition was assessed by NRS-2002 scores. Underfeeding was identified by comparing the intake against the calculated requirements. Patients were categorised into early and late EN starters to investigate if the time of EN initiation impacts the cumulative nutritional intake.
RESULTS: This study included 43 patients. Nearly, 44% of the patients were malnourished on admission to ICU and the prevalence of underfeeding was >90%. The median cumulative intake of energy and protein was 39% and 31% of the estimated requirements, respectively. Patients who started early-EN had statistically higher cumulative energy and protein intake (p-value = 0.00). Patients treated with inotropes received less energy and protein intake compared to those who did not receive inotrope (p-value = 0.00). Higher NRS-2002 score was associated with less ventilation-free hours (r = -0.369, p-value = 0.045).
CONCLUSION: Protein-underfeeding remain a significant problem in ICU settings. The time of EN initiation plays a major role in determining when the nutritional-requirements will be met. Therefore, it is crucial to implement effective feeding protocols to ensure early initiation of EN when permissible. This article is protected by copyright. All rights reserved.
METHODOLOGY: In this observational study we prospectively monitored energy and protein delivery for 6 consecutive days in critically-ill patients. Malnutrition was assessed by NRS-2002 scores. Underfeeding was identified by comparing the intake against the calculated requirements. Patients were categorised into early and late EN starters to investigate if the time of EN initiation impacts the cumulative nutritional intake.
RESULTS: This study included 43 patients. Nearly, 44% of the patients were malnourished on admission to ICU and the prevalence of underfeeding was >90%. The median cumulative intake of energy and protein was 39% and 31% of the estimated requirements, respectively. Patients who started early-EN had statistically higher cumulative energy and protein intake (p-value = 0.00). Patients treated with inotropes received less energy and protein intake compared to those who did not receive inotrope (p-value = 0.00). Higher NRS-2002 score was associated with less ventilation-free hours (r = -0.369, p-value = 0.045).
CONCLUSION: Protein-underfeeding remain a significant problem in ICU settings. The time of EN initiation plays a major role in determining when the nutritional-requirements will be met. Therefore, it is crucial to implement effective feeding protocols to ensure early initiation of EN when permissible. This article is protected by copyright. All rights reserved.
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