Impact of SPN on Infection Rate, Duration of Mechanical Ventilation & Rehabilitation in ICU Patients

• Documented Infection Rate [ Time Frame: 20 days ] [ Designated as safety issue: No ]
  Infection, defined according to CDC criteria during the ICU and hospital stay, occurrence between day 9 and day 28
  
  

• Hours on Mechanical Ventilation in All Patients [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  Mechanical ventilation hours during study duration (days 1-28)
  
  
• Antibiotic Free Days [ Time Frame: 20 days ] [ Designated as safety issue: No ]
  Number of days between day 9 to day 28 (follow-up period) free of antibiotics
  
  
• Total Energy Intake During the Intervention Period , Between Day 4 and Day 8. [ Time Frame: 5 days ] [ Designated as safety issue: No ]
  Percentage of energy target; in the SPN group the goal was to achieve 100% of the energy target during intervention (day 4 to day 8.The energy target was measured by indirect calorimetry in 198 patients of 305(65%),otherwise energy target was calculated by 25 kcal per kg of ideal body weight for women and 30 kcal per kg of ideal body weight for men and anamnestic body weight was used for patients with a body mass index of 20 kg/m2 or lower.
  
  
• General Mortality [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  
• Days in ICU [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  Days in ICU
  
  
• ICU Mortality [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  
• Protein Delivery During the Intervention Period From Day 4 to Day 8 [ Time Frame: 5 days ] [ Designated as safety issue: No ]
  Percentage of protein target between day 4 to 8. Protein target was set to 1.2 g per kg of ideal body weight a day.
  
  
• Days in Hospital [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  hospital length of stay
  
  

Introduction:

Nutritional support of the intensive care (ICU) patients is recommended as a standard of care. It is also strongly recommended to start enteral feeding as soon as possible whenever the gastrointestinal tract is functioning (1). However, studies have repeatedly shown that with enteral support alone, insufficient energy and protein intakes often occur (2). The resulting energy and protein deficit is associated with an increased complication rate in ICU patients (3-5). Recently we proposed to decrease this deficit by promoting a combined nutrition support by enteral nutrition (EN) and supplemental parenteral nutrition (SPN) whenever EN is insufficient (6).

Contrary to former beliefs, recent meta-analyses show that parenteral nutrition (PN) does not carry excess mortality (7, 8). These reports convey a concept that is a major break-through in current routine of nutritional support in ICU patients by promoting a much wider use of PN. SPN could be the optimal modality to provide the calculated energy targets if this cannot be reached by EN alone. To improve ICU patient's outcome and minimise complications, we propose to implement feeding protocols which combine both EN and PN, when EN is insufficient to cover more than 60% of caloric needs at day 4 to reach 100% of the energy targets by adding PN from day 4 (6).

Hypothesis:

The administration of SPN, in ICU patients receiving < 60% of targeted energy needs by EN alone, has a positive impact on their clinical outcome by optimising their nutritional support (reduced infectious complications rate, mechanical ventilation days, duration of ICU and hospital length of stay and rehabilitation).

Objective:

The aim of the present study is to investigate if the delivery of optimal nutrition support (100 % of predicted energy targets) in ICU patients achieved with the combined administration of SPN and EN optimizes their clinical outcome.