B. De Jonghe et al., A prospective survey of nutritional support practices in intensive care unit patients: What is prescribed? What is delivered?, CRIT CARE M, 29(1), 2001, pp. 8-12
Objectives: To assess the amount of nutrients delivered, prescribed, and re
quired for critically ill patients and to identify the reasons for discrepa
ncies between prescriptions and requirements and between prescriptions and
actual delivery of nutrition.
Design: Prospective cohort study.
Setting: Twelve-bed medical intensive care unit in a university-affiliated
general hospital.
Patients: Fifty-one consecutive patients, receiving nutritional support eit
her enterally or intravenously for greater than or equal to 2 days. We foll
owed patients for the first 14 days of nutritional delivery.
Measurements and Main Results: The amount of calories prescribed and the am
ount actually delivered were recorded daily and compared with the theoretic
al energy requirements. A combined regimen of enteral and parenteral nutrit
ion was administered on 58% of the 484 nutrition days analyzed, and 63.5% o
f total caloric intake was delivered enterally. Seventy-eight percent of th
e mean caloric amount required was prescribed, and 71% was effectively deli
vered, The amount of calories actually delivered compared with the amount p
rescribed was significantly lower in enteral than in parenteral administrat
ion (86.8% vs. 112.4%, p < .001). Discrepancies between prescription and de
livery of enterally administered nutrients were attributable to interruptio
ns caused by digestive intolerance (27.7%, mean daily wasted volume 641 mL)
, airway management (30.8%, wasted volume 745 mL), and diagnostic procedure
s (26.6%, wasted volume 567 mL). Factors significantly associated with a lo
w prescription rate of nutritional support were the administration of vasoa
ctive drugs, central venous catheterization, and the need for extrarenal re
placement.
Conclusions: An inadequate delivery of enteral nutrition and a low rate of
nutrition prescription resulted in low caloric intake in our intensive care
unit patients. A large volume of enterally administered nutrients was wast
ed because of inadequate timing in stopping and restarting enteral feeding.
The inverse correlation between the prescription rate of nutrition and the
intensity of care required suggests that physicians need to pay more atten
tion to providing appropriate nutritional support for the most severely ill
patients.