PhilSPEN Online Journal of Parenteral and Enteral Nutrition

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(Article 81 | POJ_0075)

Submitted Abstracts

PENSA 2017 Congress

Submitted: August 12, 2017

Abstract ID = 45 | Classification: (3) - Critical care and related issues

Title: Aggressive nutrition therapy for ventilated patients with high NUTRIC score in a multidisciplinary ICU in a tertiary care hospital in India: scope for protocolization?

Author(s): Uthara.U, Mahendran.S, Malarkodi. M, Prabha.V

Institution where study was conducted: Department of Dietetics, SIMS-SRM Institutes for Medical Science, Chennai, India

Keywords: NUTRIC, Protocol

Background: The NUTRIC score has been implemented for assessing the nutrition risk in mechanically ventilated patients. However, no protocols have been designed for patients with high score.

Objectives: To analyse the outcomes in ventilated patients with high NUTRIC score who received aggressive nutrition therapy. To determine the feasibility of developing a protocol to meet nutrition goals.

Methods: Medical records of all patients between September 2016 and July 2017 were reviewed. Those requiring mechanical ventilation for more than 48 hours were included. NUTRIC score was calculated (excluding IL-6).Data of patients with score ≥5 was analysed. Outcomes included length of stay (LOS) in ICU, 28- day mortality, ventilator support days, gastric residual volume(GRV), tolerance, achieving 80% target calories and protein by day 3 and progression to oral diet. Early initiation, catch-up protocol, measures to improve tolerance and daily provision of calories and protein were assessed as parameters to include in the protocol.

Results: Out of total 98 patients, 48 met inclusion criteria. Mean age was 61.56 years (±16.696) and predominantly male (68.75%).Medical cases constituted 58.3% and surgical cases 41.6%. LOS was 23.75 days (±32.09), 28-day mortality was 25%, ventilator support days of 13.63 (±16.29). Mean EN initiation time was 22.1 hours (±21.3).Achieving 80%of target calories and protein by day 3 was possible in 90.9% (±25.3) and 88.3% (±27.6).Progression to oral diet was possible in 61.1%.

Conclusion: This study demonstrates beneficial effects and feasibility of delivering aggressive volume-based nutrition support in ventilated patients with high NUTRIC score. There is scope for protocolization of nutrition therapy in these patients.