The impact of fluid therapy on nutrient delivery: a prospective evaluation of practice in respiratory intensive care.
OBJECTIVE
Concurrent therapies are not accounted for nutritional intake. This prospective clinical audit in an intensive care unit aimed at assessing the influence of fluid therapy and drugs containing nutrients on total nutrient delivery.


METHODS
Forty-four patients, 25M: 19F, age 63+/-12 (17-83)years, Acute Physiological and Chronic Health Evaluation II: 24+/-9, with length of stay >72h, were evaluated. Basal energy expenditure was estimated by the Harris-Benedict formula. All nutrients conveyed by oral, enteral, parenteral nutrition, IV solutions and drugs were daily registered and summed at the end of respiratory intensive care unit stay.


RESULTS
Mean estimated basal energy expenditure (BEE), 1372+/-432 kcal/day, was lower than mean caloric intake 2034+/-432 kcal/day (P<0.05), >BEE in 54% of patients. When dextrose/propofol were excluded, mean energy intake, 1375+/-430 kcal/day, was similar to BEE; 93% and 86% of patients had an adequate carbohydrate and lipid intake, respectively. Dextrose determined an excessive carbohydrate delivery, higher than 58% of calories, in 43% of patients, while 84% had an excessive lipid delivery due to propofol. Excessive sodium from normal saline was administered to 91% of patients, though 43% had overt oedema.


CONCLUSIONS
Hypernutrition ensued from non-quantified fluid therapy/drugs. Sodium loads may aggravate lung and gut dysfunction. The provision of "occult" calories and minerals may be quite substantial and should be taken into consideration.
Ravasco
Paula
P
Centre of Nutrition and Metabolism, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Avenida Prof. Egas Moniz, Lisbon 1649-028, Portugal.
Camilo
Maria Ermelinda
ME
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake / Q000502:physiology; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000628:therapy*; D012982:Sodium, Dietary / Q000008:administration & dosage
D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D012982:Sodium, Dietary