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PhilSPEN Online Journal of Parenteral and Enteral Nutrition

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Submitted Abstracts

PENSA 2017 Congress

Submitted: August 15, 2017

Abstract ID = 53 | Classification: (3) - Critical care and related issues

Title: The ‘SUN’ Initiative: Do we have the scope to Scale Up Nutrition in Neuro ICU?

Author(s): Radha R C (1)., Mehrotra N (2)., Chidrawar S (3)., Anita M (4)., Rajni M (5).

Institution where study was conducted:

  1. Chief Consultant Dietician & HOD, Department of Dietetics, Sunshine Hospitals, Paradise, Secunderabad, Telangana, India. radha402@gmail.com
  2. Consultant, Department of Neurosurgery, Sunshine Hospitals.
  3. Consultant, Department of Critical Care Medicine, Sunshine Hospitals
  4. and 5. Department of Dietetics, Sunshine Hospitals.

Keywords: calorie, delivery, neuro-critical care, enteral nutrition, prescription, protein

Background: Calorie and protein delivery remains challenging among neuro-critical care patients. Continued monitoring and evaluation of nutritional provision is important to identify inadequacies and determine the scope to scale up nutrition relative to evidence-based Clinical Practice Guidelines.

Objectives: The objective of the study is to assess how effective we are at delivering nutrition to the non-surgical neuro-trauma patients.

Methods: Prospective study of adult non-surgical neuro-trauma patients admitted to ICU of a tertiary-care institute during a period of 731 days. Enteral Feeding (EN) guided by a feeding protocol was evaluated in clinical practice.

Results: Of the 605patients admitted to the neuro ICU, 375 non-surgical patients between 18 and 85 years old, with 99females and 276males were monitored. The daily mean calorie and protein delivered were 1690±651.6kcal (77%) and 78.5±31.5gms (82.5%) respectively. The mean percent delivery of energy and protein improved from 35% to 95% and 39% to 97% respectively when the feed volume was increased from 25ml/hr to 100ml/hr (p<0.0001). Similarly, significant improvement in energy and protein delivery was observed when the daily feeding hours increased from 16hours to 22hours, (p<0.0001). Optimal improvements in the delivery of prescribed calories and protein were hindered by 347 feed interruptions with duration of 3007 hours (mean: 11.02h, range: 1-24h) of interruptions recorded for 176patients. When the data was segregated, it was observed that the percent adequacy of energy (70.5% vs 79%)(p=0.056) and protein (77% vs 84%)(p=0.015) significantly improved from the year 2015 to 2016. The average length of stay in the ICU reduced from 9days for 196patients during 2015 to 6days in 2016 for 179patients. There were 225 feed interruptions in 2015 as compared to 122 in 2016. As a result, the percent energy (42.8% vs 35.8%) and protein (45% vs 37%) lost during the interruptions significantly reduced from the year 2015 to 2016.

Conclusion: To prevent adverse outcomes related to nutritional deficits, nutritional support is warranted. Some of the causes for discrepancies between prescribed and received EN are unavoidable, but many are not, suggesting the need for careful review and possible alteration of existing EN practices. Findings from this study are important as they form the foundation for the development of evidence-based care that is badly needed to eliminate underfeeding in this large vulnerable Indian ICU population.

Email: radha402@gmail.com

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