A retrospective study about the influence of early nutritional support on mortality and nosocomial infection in the critical care setting

Summary Background & aims To determine whether early nutritional support reduces mortality and the incidence of nosocomial infection, in critically ill patients in the current practice. Methods A retrospective observational study was conducted in all critically ill patients who had been prescrib...

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Veröffentlicht in:Clinical nutrition (Edinburgh, Scotland) Scotland), 2011-06, Vol.30 (3), p.346-350
Hauptverfasser: Serón-Arbeloa, C, Puzo-Foncillas, J, Garcés- Gimenez, T, Escós-Orta, J, Labarta-Monzón, L, Lander-Azcona, A
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container_end_page 350
container_issue 3
container_start_page 346
container_title Clinical nutrition (Edinburgh, Scotland)
container_volume 30
creator Serón-Arbeloa, C
Puzo-Foncillas, J
Garcés- Gimenez, T
Escós-Orta, J
Labarta-Monzón, L
Lander-Azcona, A
description Summary Background & aims To determine whether early nutritional support reduces mortality and the incidence of nosocomial infection, in critically ill patients in the current practice. Methods A retrospective observational study was conducted in all critically ill patients who had been prescribed nutritional support, throughout one year, in an Intensive Care Unit. The time to start and the route of delivery of nutritional support were determined by the attending clinician’s assessment of gastrointestinal function and hemodynamic stability. Age, gender, severity of illness, start time and route of nutritional support, prescribed and delivered daily caloric intake for the first 7 days, whether they were a medical or surgical patient, length of stay in ICU, incidence rate of nosocomial infections and ICU mortality were recorded. Patients were classified according to whether or not they received nutritional support within 48 h of their admission to ICU and Binary Logistic Regression was performed to assess the effect of early nutritional support on ICU mortality and ICU nosocomial infections after controlling for confounders. Results Ninety-two consecutive patients were included in the study. Start time of nutritional support showed a mean of 3.1 ± 1.9 days. Patients in the early nutritional support group had a lower ICU mortality in an unadjusted analysis (20% vs. 40.4%, p  = 0.033). Early nutritional support was found to be an independent predictor of mortality in the regression analysis model (OR 0,28; 95% confidence interval, 0.09 to 0,84; p  = 0.023). Our study did not demonstrate any association between early nutritional support and the incidence of nosocomial infection (OR 0.77; 95%. confidence interval, 0.26 to 2,24; p  = 0.63), which was related to the route of nutritional support and the caloric intake. The delayed nutritional support group showed a longer length of stay and nosocomial infections than the early group, although these differences were not statistically significant. Conclusions Our study shows that early nutrition support reduces ICU mortality in critically ill patients, although it does not demonstrate any influence over nosocomial infection in the current practice in intensive care.
doi_str_mv 10.1016/j.clnu.2010.11.004
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Methods A retrospective observational study was conducted in all critically ill patients who had been prescribed nutritional support, throughout one year, in an Intensive Care Unit. The time to start and the route of delivery of nutritional support were determined by the attending clinician’s assessment of gastrointestinal function and hemodynamic stability. Age, gender, severity of illness, start time and route of nutritional support, prescribed and delivered daily caloric intake for the first 7 days, whether they were a medical or surgical patient, length of stay in ICU, incidence rate of nosocomial infections and ICU mortality were recorded. Patients were classified according to whether or not they received nutritional support within 48 h of their admission to ICU and Binary Logistic Regression was performed to assess the effect of early nutritional support on ICU mortality and ICU nosocomial infections after controlling for confounders. Results Ninety-two consecutive patients were included in the study. Start time of nutritional support showed a mean of 3.1 ± 1.9 days. Patients in the early nutritional support group had a lower ICU mortality in an unadjusted analysis (20% vs. 40.4%, p  = 0.033). Early nutritional support was found to be an independent predictor of mortality in the regression analysis model (OR 0,28; 95% confidence interval, 0.09 to 0,84; p  = 0.023). Our study did not demonstrate any association between early nutritional support and the incidence of nosocomial infection (OR 0.77; 95%. confidence interval, 0.26 to 2,24; p  = 0.63), which was related to the route of nutritional support and the caloric intake. The delayed nutritional support group showed a longer length of stay and nosocomial infections than the early group, although these differences were not statistically significant. Conclusions Our study shows that early nutrition support reduces ICU mortality in critically ill patients, although it does not demonstrate any influence over nosocomial infection in the current practice in intensive care.</description><identifier>ISSN: 0261-5614</identifier><identifier>EISSN: 1532-1983</identifier><identifier>DOI: 10.1016/j.clnu.2010.11.004</identifier><identifier>PMID: 21131108</identifier><identifier>CODEN: CLNUDP</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Aged ; Biological and medical sciences ; confidence interval ; Critical Care - statistics &amp; numerical data ; Critical Illness - mortality ; Critically ill patients ; cross infection ; Cross Infection - complications ; Cross Infection - epidemiology ; disease control ; Early nutritional support ; Energy Intake ; Evidence-Based Medicine ; Feeding. Feeding behavior ; Female ; Fundamental and applied biological sciences. Psychology ; Gastroenterology and Hepatology ; gender ; General aspects ; Hospitals, General ; Human infectious diseases. Experimental studies and models ; Humans ; Incidence ; Infectious diseases ; Intensive Care Units - statistics &amp; numerical data ; Length of Stay ; Male ; Medical sciences ; Middle Aged ; mortality ; Nutritional outcomes ; nutritional support ; Nutritional Support - methods ; Overnutrition - complications ; patients ; Practice Guidelines as Topic ; regression analysis ; Retrospective Studies ; Spain - epidemiology ; Time Factors ; Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><ispartof>Clinical nutrition (Edinburgh, Scotland), 2011-06, Vol.30 (3), p.346-350</ispartof><rights>Elsevier Ltd and European Society for Clinical Nutrition and Metabolism</rights><rights>2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. 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Methods A retrospective observational study was conducted in all critically ill patients who had been prescribed nutritional support, throughout one year, in an Intensive Care Unit. The time to start and the route of delivery of nutritional support were determined by the attending clinician’s assessment of gastrointestinal function and hemodynamic stability. Age, gender, severity of illness, start time and route of nutritional support, prescribed and delivered daily caloric intake for the first 7 days, whether they were a medical or surgical patient, length of stay in ICU, incidence rate of nosocomial infections and ICU mortality were recorded. Patients were classified according to whether or not they received nutritional support within 48 h of their admission to ICU and Binary Logistic Regression was performed to assess the effect of early nutritional support on ICU mortality and ICU nosocomial infections after controlling for confounders. Results Ninety-two consecutive patients were included in the study. Start time of nutritional support showed a mean of 3.1 ± 1.9 days. Patients in the early nutritional support group had a lower ICU mortality in an unadjusted analysis (20% vs. 40.4%, p  = 0.033). Early nutritional support was found to be an independent predictor of mortality in the regression analysis model (OR 0,28; 95% confidence interval, 0.09 to 0,84; p  = 0.023). Our study did not demonstrate any association between early nutritional support and the incidence of nosocomial infection (OR 0.77; 95%. confidence interval, 0.26 to 2,24; p  = 0.63), which was related to the route of nutritional support and the caloric intake. The delayed nutritional support group showed a longer length of stay and nosocomial infections than the early group, although these differences were not statistically significant. 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Experimental studies and models</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infectious diseases</topic><topic>Intensive Care Units - statistics &amp; numerical data</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>mortality</topic><topic>Nutritional outcomes</topic><topic>nutritional support</topic><topic>Nutritional Support - methods</topic><topic>Overnutrition - complications</topic><topic>patients</topic><topic>Practice Guidelines as Topic</topic><topic>regression analysis</topic><topic>Retrospective Studies</topic><topic>Spain - epidemiology</topic><topic>Time Factors</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Serón-Arbeloa, C</creatorcontrib><creatorcontrib>Puzo-Foncillas, J</creatorcontrib><creatorcontrib>Garcés- Gimenez, T</creatorcontrib><creatorcontrib>Escós-Orta, J</creatorcontrib><creatorcontrib>Labarta-Monzón, L</creatorcontrib><creatorcontrib>Lander-Azcona, A</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><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>Serón-Arbeloa, C</au><au>Puzo-Foncillas, J</au><au>Garcés- Gimenez, T</au><au>Escós-Orta, J</au><au>Labarta-Monzón, L</au><au>Lander-Azcona, A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A retrospective study about the influence of early nutritional support on mortality and nosocomial infection in the critical care setting</atitle><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle><addtitle>Clin Nutr</addtitle><date>2011-06-01</date><risdate>2011</risdate><volume>30</volume><issue>3</issue><spage>346</spage><epage>350</epage><pages>346-350</pages><issn>0261-5614</issn><eissn>1532-1983</eissn><coden>CLNUDP</coden><abstract>Summary Background &amp; aims To determine whether early nutritional support reduces mortality and the incidence of nosocomial infection, in critically ill patients in the current practice. Methods A retrospective observational study was conducted in all critically ill patients who had been prescribed nutritional support, throughout one year, in an Intensive Care Unit. The time to start and the route of delivery of nutritional support were determined by the attending clinician’s assessment of gastrointestinal function and hemodynamic stability. Age, gender, severity of illness, start time and route of nutritional support, prescribed and delivered daily caloric intake for the first 7 days, whether they were a medical or surgical patient, length of stay in ICU, incidence rate of nosocomial infections and ICU mortality were recorded. Patients were classified according to whether or not they received nutritional support within 48 h of their admission to ICU and Binary Logistic Regression was performed to assess the effect of early nutritional support on ICU mortality and ICU nosocomial infections after controlling for confounders. Results Ninety-two consecutive patients were included in the study. Start time of nutritional support showed a mean of 3.1 ± 1.9 days. Patients in the early nutritional support group had a lower ICU mortality in an unadjusted analysis (20% vs. 40.4%, p  = 0.033). Early nutritional support was found to be an independent predictor of mortality in the regression analysis model (OR 0,28; 95% confidence interval, 0.09 to 0,84; p  = 0.023). Our study did not demonstrate any association between early nutritional support and the incidence of nosocomial infection (OR 0.77; 95%. confidence interval, 0.26 to 2,24; p  = 0.63), which was related to the route of nutritional support and the caloric intake. The delayed nutritional support group showed a longer length of stay and nosocomial infections than the early group, although these differences were not statistically significant. Conclusions Our study shows that early nutrition support reduces ICU mortality in critically ill patients, although it does not demonstrate any influence over nosocomial infection in the current practice in intensive care.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>21131108</pmid><doi>10.1016/j.clnu.2010.11.004</doi><tpages>5</tpages></addata></record>
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subjects Aged
Biological and medical sciences
confidence interval
Critical Care - statistics & numerical data
Critical Illness - mortality
Critically ill patients
cross infection
Cross Infection - complications
Cross Infection - epidemiology
disease control
Early nutritional support
Energy Intake
Evidence-Based Medicine
Feeding. Feeding behavior
Female
Fundamental and applied biological sciences. Psychology
Gastroenterology and Hepatology
gender
General aspects
Hospitals, General
Human infectious diseases. Experimental studies and models
Humans
Incidence
Infectious diseases
Intensive Care Units - statistics & numerical data
Length of Stay
Male
Medical sciences
Middle Aged
mortality
Nutritional outcomes
nutritional support
Nutritional Support - methods
Overnutrition - complications
patients
Practice Guidelines as Topic
regression analysis
Retrospective Studies
Spain - epidemiology
Time Factors
Vertebrates: anatomy and physiology, studies on body, several organs or systems
title A retrospective study about the influence of early nutritional support on mortality and nosocomial infection in the critical care setting
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