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Meeting Calorie and Protein Needs in the Critical Care Unit: A Prospective Observational Pilot Study.

ABSTRACT: Background:Inadequate calorie and protein intake during critical illness is associated with poor clinical outcomes. Unfortunately, most critically ill patients do not consume adequate levels of these nutrients. An enteral formula with appropriate macronutrient composition may assist patients in meeting nutritional goals. Design:This study was a single center, prospective, observational study of 29 adults in the medical intensive care unit who required enteral nutrition for at least 3?days. Subjects received a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula for up to 5?days to assess the ability to achieve 50% of caloric goals within the first 3?days (primary outcome), the daily percentage of protein goals attained and gastrointestinal tolerance (secondary outcomes). Result:A total of 29 subjects consented and began the study. Four subjects dropped out before first day and 25 subjects were included in analyses. Subjects were aged 55.5?±?16.9?years with mean body mass index (BMI) of 27.9?±?7.5?kg/m2. Most (92%) subjects were on a mechanical ventilator and experienced organ failure. At least 50% of caloric and protein goals were achieved in 78.9% and 73.7% of the subjects, respectively, during the first 3?days. Overall, 75.0?±?26.3% and 69.3?±?26.7% of calorie and protein goals were achieved using the study formula. Conclusions:Subjects fed enterally with a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula exceeded 50% of caloric and protein goals in most critically ill subjects included in this study. Use of study formula did not lead to severe gastrointestinal intolerance.

SUBMITTER: Yamamoto S

PROVIDER: S-EPMC7045298 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Meeting Calorie and Protein Needs in the Critical Care Unit: A Prospective Observational Pilot Study.

Yamamoto Shinobu S Allen Karen K Jones Kellie R KR Cohen Sarah S SS Reyes Kemuel K Huhmann Maureen B MB

Nutrition and metabolic insights 20200226

<h4>Background</h4>Inadequate calorie and protein intake during critical illness is associated with poor clinical outcomes. Unfortunately, most critically ill patients do not consume adequate levels of these nutrients. An enteral formula with appropriate macronutrient composition may assist patients in meeting nutritional goals.<h4>Design</h4>This study was a single center, prospective, observational study of 29 adults in the medical intensive care unit who required enteral nutrition for at leas ...[more]

PMID: 32153344

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Project description:BACKGROUND:Cancer impacts on patients and their families across a range of different domains. For that reason, optimal cancer care has moved away from a disease-centric focus to a more holistic approach in order to proactively support people with their individual needs and concerns. While international policy clearly advocates this agenda, implementation into routine care is limited. Therefore, relevant interventions that measurably improve patient outcomes are essential to understand if this ideal is to become routine multidisciplinary practice. The aim of this study was to analyse the impact of a proactive, holistic, community-based intervention on health-related quality of life in a cohort of people diagnosed with cancer. Secondary aim was to explore the relationship between changes in health status and: cancer type, cancer stage, number of concerns expressed and change in severity of concerns pre and post intervention. METHOD:Prospective observational cohort study. A convenience sample of 437 individuals were referred to the service 'Improving the Cancer Journey (ICJ) in the UK. Each completed the Euroqol EQ-5D-3?L and visual analogue scale (VAS) and a Holistic Needs Assessment (HNA) during initial visit to the service and again at follow-up review, median 84?days later. Change between scores was tested with paired t-tests and relationships between variables with multiple regression models with heteroscedasticity-consistent standard errors. RESULTS:Participants were White British with median age between 50 and 64?years. Cancer type and stage were varied. EQ-5D utility scores improved at follow-up by 0.121 [0.0891-0.153], p <?.001, and VAS scores improved by 7.81 [5.88-9.74], p <?.001. The strongest predictor of change was a decrease in severity of concerns. Cancer stage 'palliative care' contributed to a reduction in health status. CONCLUSION:This study is the first to show that a holistic community intervention dedicated to supporting the individual concerns of participants had both a statistically significant and clinically meaningful impact on participants' health-related quality of life. The mean change in EQ-5D scores was more than the 'minimally important clinical difference' described in the literature. This is important because while quality of life has multiple determinants, this study has shown for the first time that it is possible to capture a clinically meaningful improvement as a function of reducing someone's personally identified concerns.

Project description:BackgroundMany studies have compared quality of life of post-intensive care syndrome (PICS) patients with age-matched population-based controls. Many studies on PICS used the 36-item Short Form (SF-36) health survey questionnaire version 2, but lack the data for SF-36 values before and after intensive care unit (ICU) admission. Thus, clinically important changes in the parameters of SF-36 are unknown. Therefore, we determined the frequency of co-occurrence of PICS impairments at 6 months after ICU admission. We also evaluated the changes in SF-36 subscales and interpreted the patients' subjective significance of impairment.MethodsA prospective, multicenter, observational cohort study was conducted in 16 ICUs across 14 hospitals in Japan. Adult ICU patients expected to receive mechanical ventilation for > 48 h were enrolled, and their 6-month outcome was assessed using the questionnaires. PICS definition was based on the physical status, indicated by the change in SF-36 physical component score (PCS) ≥ 10 points; mental status, indicated by the change in SF-36 mental component score (MCS) ≥ 10 points; and cognitive function, indicated by the worsening of Short-Memory Questionnaire (SMQ) score and SMQ score at 6 months < 40. Multivariate logistic regression model was used to identify the factors associated with PICS occurrence. The patients' subjective significance of physical and mental symptoms was assessed using the 7-scale Global Assessment Rating to evaluate minimal clinically important difference (MCID).ResultsAmong 192 patients, 48 (25%) died at 6 months. Among the survivors at 6 months, 96 patients responded to the questionnaire; ≥ 1 PICS impairment occurred in 61 (63.5%) patients, and ≥ 2 occurred in 17 (17.8%) patients. Physical, mental, and cognitive impairments occurred in 32.3%, 14.6% and 37.5% patients, respectively. Population with only mandatory education was associated with PICS occurrence (odds ratio: 4.0, 95% CI 1.1-18.8, P = 0.029). The MCID of PCS and MCS scores was 6.5 and 8.0, respectively.ConclusionsAmong the survivors who received mechanical ventilation, 64% had PICS at 6 months; co-occurrence of PICS impairments occurred in 20%. PICS was associated with population with only mandatory education. Future studies elucidating the MCID of SF-36 scores among ICU patients and standardizing the PICS definition are required. Trial registration UMIN000034072.

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Meeting Calorie and Protein Needs in the Critical Care Unit: A Prospective Observational Pilot Study.

Publications

Meeting Calorie and Protein Needs in the Critical Care Unit: A Prospective Observational Pilot Study.

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