Critical Illness, Elderly, Mechanical Ventilation
Conditions
Keywords
Indirect Calorimetry, Harris-Benedict equation, critical elderly, mNUTRIC score, high nutritional risk
Brief summary
The purposes of this study were to investigate the caloric requirement and clinical outcomes in mechanically ventilated critically ill elderly patients and identify those at high nutritional risk who require high protein formula intervention.
Detailed description
The elderly population is rapidly increasing, but studies on calorie requirement in critically ill elderly patients are few, and indirect calorimetry (IC) is not available in every intensive care unit (ICU). The aim of this study was to compare IC and Harris-Benedict (HB) predictive equation in different BMI (body mass index) groups. And to investigate whether the nutrition intake from EN (enteral nutrition) and PN (parenteral nutrition) created a better clinical outcome than EN alone in HNR (high nutritional risk) mechanically ventilated critically ill elderly patients.Inclusion criteria were: age ≧65 years old, APACHE Π score ≧15, mechanical ventilation ≧48 hours and on NG tube feeding. Nutritional risk was screened by mNUTRIC and GNRI. Indirect calorimetry and HB equation were used to assess energy requirements. Patients were randomized 1:1 to two tube feeding regimens: general formula and high protein formula (1.5\ 2.0 gm/kg BW). Nutritional intake from EN, the type and amount of intravenous nutrition within 7 days, tolerance to feeding, MVD (Mechanical Ventilation Day), newly diagnosed VAP (Ventilator Associated Pneumonia), ICU and hospital LOS (Length of Stay) and date of death were recorded. We used SAS version 9.4 for statistical analysis. Statistically significance was set at α=0.05.
Interventions
DIETARY_SUPPLEMENThigh protein enteral nutrition
supply protein over 1.5 gm/kg body weight
Sponsors
Mackay Memorial Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Patients were randomized 1:1 to two tube feeding regimens: general formula and high protein formula (1.5\ 2.0 gm/kg BW).
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* APACHE Π score ≧ 15 * ≧ 65 years * on mechanical ventilation ≧48 hours * received EN
Exclusion criteria
* Use of total parenteral nutrition * Fasting \>5 days * Brain death * Terminal cancer
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Determination of the energy requirements in critically ill elderly patients | first 5 days in the ICU | A total of 177 critically ill elderly patients (≧ 65 years old) underwent IC for measured resting energy expenditure (MREE). Estimated calorie requirement was calculated by the HB equation, using actual body weight (ABW) and ideal body weight (IBW) separately. Patients were divided into four BMI groups. One-way ANOVA and Pearson's correlation coefficient were used for statistical analyses. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Higher Enteral Nutrition Intake May Reduce Hospital Mortality | first 28 days in the ICU | We included patients ≧ 65 years on mechanical ventilation ≧ 48 hours and received EN. Nutritional status was evaluated by mNUTRIC score. We calculated the energy and protein requirements as Harris-Benedict equation ╳ 1.0\ 1.3 and 1.0\ 2.0 gm/kg body weight respectively. Nutrition intake from EN and PN was recorded within 7 days. ICU and hospital mortalities in HNR elderly patients who could achieve more or less 80% of the prescribed nutrition were compared. |
Countries
Taiwan
Outcome results
None listed