Impact of the reduction of the recommended energy target in the ICU on protein delivery and clinical outcomes
Summary Background & aims Energy targets are a matter of debate for intensive care (ICU) patients. As the guidelines have evolved, energy targets have been reduced, while the protein intake objectives have increased. The impact of these changes remains largely unknown. This quality study aimed a...
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| Veröffentlicht in: | Clinical nutrition (Edinburgh, Scotland) Scotland), 2017-02, Vol.36 (1), p.281-287 |
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| creator | Berger, M.M Soguel, L Charrière, M Thériault, B Pralong, F Schaller, M.D |
| description | Summary Background & aims Energy targets are a matter of debate for intensive care (ICU) patients. As the guidelines have evolved, energy targets have been reduced, while the protein intake objectives have increased. The impact of these changes remains largely unknown. This quality study aimed at investigating the clinical impact of these changes in patients with an ICU stay >3 days. Methods Observational cohort study over two 3 months periods (A, B), with distinct prevailing nutrition recommendations in patients admitted consecutively to a multidisciplinary ICU. Inclusion criterion: ICU stay >3 days. Recorded variables: severity scores, energy target and delivery, protein delivery, feeding route, length of stay (ICU, hospital) and hospital outcome. Data as mean, SD and IQR. Results The analysis included 389 patients, and 3920 observation days. Except for patient age (A versus B: 57.8 and 62.3 years; p = 0.010) and NRS (4.3 vs 3.9 respectively p = 0.002), the cohorts were similar. Compared to A, the mean prescribed energy target decreased by 125 kcal (1947 kcal/d vs. 1822 kcal*day−1 respectively), resulting in lower energy delivery (1353 kcal*day−1 vs. 1238 kcal*day−1 ; p |
| doi_str_mv | 10.1016/j.clnu.2015.12.002 |
| format | Article |
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As the guidelines have evolved, energy targets have been reduced, while the protein intake objectives have increased. The impact of these changes remains largely unknown. This quality study aimed at investigating the clinical impact of these changes in patients with an ICU stay >3 days. Methods Observational cohort study over two 3 months periods (A, B), with distinct prevailing nutrition recommendations in patients admitted consecutively to a multidisciplinary ICU. Inclusion criterion: ICU stay >3 days. Recorded variables: severity scores, energy target and delivery, protein delivery, feeding route, length of stay (ICU, hospital) and hospital outcome. Data as mean, SD and IQR. Results The analysis included 389 patients, and 3920 observation days. Except for patient age (A versus B: 57.8 and 62.3 years; p = 0.010) and NRS (4.3 vs 3.9 respectively p = 0.002), the cohorts were similar. Compared to A, the mean prescribed energy target decreased by 125 kcal (1947 kcal/d vs. 1822 kcal*day−1 respectively), resulting in lower energy delivery (1353 kcal*day−1 vs. 1238 kcal*day−1 ; p < 0.0001), and reduced protein delivery (81 g*day−1 vs. 65 g*day−1 : p < 0.0001). These differences were associated in survivors with prolonged mechanical ventilation (5.0 days vs. 6.7 days; p = 0.004), extended ICU stay (8.5 vs. 9.9 days; p = 0.0036), and longer hospital stay (23.4 vs. 26.4 days respectively; p = 0.028). Mortality was unchanged. Conclusions A linear reduction in energy target recommendation without changing the feed composition led to an unplanned and significant reduction in protein delivery, which was associated with a prolonged duration of ventilation and an extended hospital stay.</description><identifier>ISSN: 0261-5614</identifier><identifier>EISSN: 1532-1983</identifier><identifier>DOI: 10.1016/j.clnu.2015.12.002</identifier><identifier>PMID: 26775753</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Aged ; Cohort Studies ; Critical care ; Critical Illness - therapy ; Dietary Proteins - administration & dosage ; Female ; Gastroenterology and Hepatology ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Malnutrition ; Middle Aged ; Monitoring ; Nutrition Policy ; Nutritional Requirements ; Nutritional Status ; Outcome ; Protein requirements ; Recommended Dietary Allowances ; Respiration, Artificial ; Treatment Outcome</subject><ispartof>Clinical nutrition (Edinburgh, Scotland), 2017-02, Vol.36 (1), p.281-287</ispartof><rights>Elsevier Ltd and European Society for Clinical Nutrition and Metabolism</rights><rights>2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism</rights><rights>Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-4727d8287ee171c651462bdaf009101ab9426e7536e0d8a603b97e9813b244f23</citedby><cites>FETCH-LOGICAL-c411t-4727d8287ee171c651462bdaf009101ab9426e7536e0d8a603b97e9813b244f23</cites><orcidid>0000-0002-0669-0343 ; 0000-0002-0739-0713</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0261561415003398$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26775753$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Berger, M.M</creatorcontrib><creatorcontrib>Soguel, L</creatorcontrib><creatorcontrib>Charrière, M</creatorcontrib><creatorcontrib>Thériault, B</creatorcontrib><creatorcontrib>Pralong, F</creatorcontrib><creatorcontrib>Schaller, M.D</creatorcontrib><title>Impact of the reduction of the recommended energy target in the ICU on protein delivery and clinical outcomes</title><title>Clinical nutrition (Edinburgh, Scotland)</title><addtitle>Clin Nutr</addtitle><description>Summary Background & aims Energy targets are a matter of debate for intensive care (ICU) patients. As the guidelines have evolved, energy targets have been reduced, while the protein intake objectives have increased. The impact of these changes remains largely unknown. This quality study aimed at investigating the clinical impact of these changes in patients with an ICU stay >3 days. Methods Observational cohort study over two 3 months periods (A, B), with distinct prevailing nutrition recommendations in patients admitted consecutively to a multidisciplinary ICU. Inclusion criterion: ICU stay >3 days. Recorded variables: severity scores, energy target and delivery, protein delivery, feeding route, length of stay (ICU, hospital) and hospital outcome. Data as mean, SD and IQR. Results The analysis included 389 patients, and 3920 observation days. Except for patient age (A versus B: 57.8 and 62.3 years; p = 0.010) and NRS (4.3 vs 3.9 respectively p = 0.002), the cohorts were similar. Compared to A, the mean prescribed energy target decreased by 125 kcal (1947 kcal/d vs. 1822 kcal*day−1 respectively), resulting in lower energy delivery (1353 kcal*day−1 vs. 1238 kcal*day−1 ; p < 0.0001), and reduced protein delivery (81 g*day−1 vs. 65 g*day−1 : p < 0.0001). These differences were associated in survivors with prolonged mechanical ventilation (5.0 days vs. 6.7 days; p = 0.004), extended ICU stay (8.5 vs. 9.9 days; p = 0.0036), and longer hospital stay (23.4 vs. 26.4 days respectively; p = 0.028). Mortality was unchanged. Conclusions A linear reduction in energy target recommendation without changing the feed composition led to an unplanned and significant reduction in protein delivery, which was associated with a prolonged duration of ventilation and an extended hospital stay.</description><subject>Adult</subject><subject>Aged</subject><subject>Cohort Studies</subject><subject>Critical care</subject><subject>Critical Illness - therapy</subject><subject>Dietary Proteins - administration & dosage</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Humans</subject><subject>Intensive Care Units</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Malnutrition</subject><subject>Middle Aged</subject><subject>Monitoring</subject><subject>Nutrition Policy</subject><subject>Nutritional Requirements</subject><subject>Nutritional Status</subject><subject>Outcome</subject><subject>Protein requirements</subject><subject>Recommended Dietary Allowances</subject><subject>Respiration, Artificial</subject><subject>Treatment Outcome</subject><issn>0261-5614</issn><issn>1532-1983</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFv1DAQhS1ERbeFP8AB-cglweMkdiIhJLSiZaVKHErPlmNPipfEWWyn0v57nG4LEgdOI43ee5r5HiFvgZXAQHzYl2b0S8kZNCXwkjH-gmygqXgBXVu9JBvGBRSNgPqcXMS4Z4w1lWxfkXMupGxkU23ItJsO2iQ6DzT9QBrQLia52f9dmHma0Fu0FD2G-yNNOtxjos4_CnbbO5rlhzAnzCuLo3vAcKTaW2pG553RI52XlGMwviZngx4jvnmal-Tu6sv37dfi5tv1bvv5pjA1QCpqyaVteSsRQYIRDdSC91YPjHX5c913NReY7xfIbKsFq_pOYtdC1fO6Hnh1Sd6fcvNZvxaMSU0uGhxH7XFeooKWC1G3OSxL-UlqwhxjwEEdgpt0OCpgasWs9mrFrFbMCrjKmLPp3VP-0k9o_1ieuWbBx5MA85cPDoOKxqE3aF0mmpSd3f_zP_1jf0b5E48Y9_MSfOanQMVsULdr0WvP0DBWVbn839zRopA</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Berger, M.M</creator><creator>Soguel, L</creator><creator>Charrière, M</creator><creator>Thériault, B</creator><creator>Pralong, F</creator><creator>Schaller, M.D</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0669-0343</orcidid><orcidid>https://orcid.org/0000-0002-0739-0713</orcidid></search><sort><creationdate>20170201</creationdate><title>Impact of the reduction of the recommended energy target in the ICU on protein delivery and clinical outcomes</title><author>Berger, M.M ; Soguel, L ; Charrière, M ; Thériault, B ; Pralong, F ; Schaller, M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-4727d8287ee171c651462bdaf009101ab9426e7536e0d8a603b97e9813b244f23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Cohort Studies</topic><topic>Critical care</topic><topic>Critical Illness - therapy</topic><topic>Dietary Proteins - administration & dosage</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Malnutrition</topic><topic>Middle Aged</topic><topic>Monitoring</topic><topic>Nutrition Policy</topic><topic>Nutritional Requirements</topic><topic>Nutritional Status</topic><topic>Outcome</topic><topic>Protein requirements</topic><topic>Recommended Dietary Allowances</topic><topic>Respiration, Artificial</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Berger, M.M</creatorcontrib><creatorcontrib>Soguel, L</creatorcontrib><creatorcontrib>Charrière, M</creatorcontrib><creatorcontrib>Thériault, B</creatorcontrib><creatorcontrib>Pralong, F</creatorcontrib><creatorcontrib>Schaller, M.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Berger, M.M</au><au>Soguel, L</au><au>Charrière, M</au><au>Thériault, B</au><au>Pralong, F</au><au>Schaller, M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of the reduction of the recommended energy target in the ICU on protein delivery and clinical outcomes</atitle><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle><addtitle>Clin Nutr</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>36</volume><issue>1</issue><spage>281</spage><epage>287</epage><pages>281-287</pages><issn>0261-5614</issn><eissn>1532-1983</eissn><abstract>Summary Background & aims Energy targets are a matter of debate for intensive care (ICU) patients. As the guidelines have evolved, energy targets have been reduced, while the protein intake objectives have increased. The impact of these changes remains largely unknown. This quality study aimed at investigating the clinical impact of these changes in patients with an ICU stay >3 days. Methods Observational cohort study over two 3 months periods (A, B), with distinct prevailing nutrition recommendations in patients admitted consecutively to a multidisciplinary ICU. Inclusion criterion: ICU stay >3 days. Recorded variables: severity scores, energy target and delivery, protein delivery, feeding route, length of stay (ICU, hospital) and hospital outcome. Data as mean, SD and IQR. Results The analysis included 389 patients, and 3920 observation days. Except for patient age (A versus B: 57.8 and 62.3 years; p = 0.010) and NRS (4.3 vs 3.9 respectively p = 0.002), the cohorts were similar. Compared to A, the mean prescribed energy target decreased by 125 kcal (1947 kcal/d vs. 1822 kcal*day−1 respectively), resulting in lower energy delivery (1353 kcal*day−1 vs. 1238 kcal*day−1 ; p < 0.0001), and reduced protein delivery (81 g*day−1 vs. 65 g*day−1 : p < 0.0001). These differences were associated in survivors with prolonged mechanical ventilation (5.0 days vs. 6.7 days; p = 0.004), extended ICU stay (8.5 vs. 9.9 days; p = 0.0036), and longer hospital stay (23.4 vs. 26.4 days respectively; p = 0.028). Mortality was unchanged. Conclusions A linear reduction in energy target recommendation without changing the feed composition led to an unplanned and significant reduction in protein delivery, which was associated with a prolonged duration of ventilation and an extended hospital stay.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>26775753</pmid><doi>10.1016/j.clnu.2015.12.002</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0669-0343</orcidid><orcidid>https://orcid.org/0000-0002-0739-0713</orcidid></addata></record> |
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| subjects | Adult Aged Cohort Studies Critical care Critical Illness - therapy Dietary Proteins - administration & dosage Female Gastroenterology and Hepatology Humans Intensive Care Units Length of Stay Male Malnutrition Middle Aged Monitoring Nutrition Policy Nutritional Requirements Nutritional Status Outcome Protein requirements Recommended Dietary Allowances Respiration, Artificial Treatment Outcome |
| title | Impact of the reduction of the recommended energy target in the ICU on protein delivery and clinical outcomes |
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