Nutritional assessment of critically ill patients in the NICU according to ESPEN guidelines

Abstract

Introduction Critically ill patients, especially with acute neurologic injury, are in higher risk of malnutrition because of a hypermetabolic state which results in an excessive release of stress hormones and pro-inflammatory cytokines that alter energy and protein metabolism and eventually leads to malnutrition. Malnutrition is associated with adverse clinical outcomes, therefore the proper nutritional support is essential for these patients. Aim To analyse the nutrition support of enterally fed patients admitted to the Neurosurgery Intensive Care Unit (NICU) of the Hospital of Lithuanian University of Health Sciences (LUHS) Kaunas Clinics and to compare according to the latest European Society forClinical Nutrition and Metabolism (ESPEN) guidelines. Methods The data for this observational study was collected from November 10th to December 10th 2021. Data was gathered by independent nonbiased concealed observers via objective information collection from prescriptions. All patients who spent more than 24h in the ICU on enteral nutrition were included in the study. Nutritional needs were assessed using VCO2 parameter, when possible, or formula of 20-25 kcal/kg in the absence of VCO2 and using adjusted body weight for patients with BMI >30. The results were compared with the ESPEN guidelines for clinical nutrition in the intensive care unit. Statistical analysis ofthe data was performed using the IBM SPSS Statistics 22 software package.The Chi- square test was used to determine the relationship between variables. A significance level of 0.05 was chosen to test statistical hypotheses. Results The approval for study was given by the Bioethics Center of LUHS (protocol number BEC- MF-61). The nutrition of 26 patients, 19 men and 7 women with the mean age of 66.08±14.792 (range 29 -92) was assessed. 11 patients (42.3%) were hospitalized after a stroke, 11 (42.3%) after brain trauma, 2 (7.7%) had a neuro-infection and 2 (7.7%) had other diagnoses. Patient's mean BMI was 27.43±4.99 (range 18.59 - 42.9).The average time to start feeding was 2 days, but for 3 patients (11.5%) nutritional therapy started on day 3 or later and the reasons for this remained unclear. Caloric needs were met in 19 (73.1%) patients and protein needs in 20 (76,9%) patients in 3.89±2.998 and 5.05±3.649 days respectively, but only 61,6% (16) of patients reached their caloric intake within the recommended period of 7 days. Patients with a BMI of 25-29,99 were more likely to not reach their caloric needs and to have their calory and protein requirements calculated according to ideal or adjusted body weight instead of normal body weight (χ2 = 12.505, p = 0.014). Conclusions Most of the NICU patients the enteral feeding was started according ESPEN guidelines and caloric intake and protein requirements were reached. The overweight patients were at higher risk of malnutrition.