title: Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes.
abstract: OBJECTIVE
  To assess the consistency of caloric intake with American College of Chest Physicians (ACCP) recommendations for critically ill patients and to evaluate the relationship of caloric intake with clinical outcomes.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Adult ICUs at two teaching hospitals.
  
  
  METHODS
  Patients with an ICU length of stay of at least 96 h.
  
  
  RESULTS
  On ICU admission, severity of illness (ie, simplified acute physiology score II) and markers of nutritional status (ie, serum albumin level and body mass index) were recorded. The route of feeding (ie, enteral or parenteral), actual caloric intake (ie, percentage of ACCP recommendations: 0 to 32% [tertile I]; 33 to 65% [tertile II]; >/==" BORDER="0"> 66% [tertile III]), and evidence of GI intolerance (ie, gastric aspirate levels, >/==" BORDER="0"> 100 mL) were recorded daily. The following outcomes were assessed: status on hospital discharge (alive vs dead); spontaneous ventilation before ICU discharge (yes vs no); and ICU discharge without developing nosocomial sepsis (yes vs no). The average caloric intake among 187 participants was 50.6% of the ACCP targets and was similar in both hospitals. Caloric intake was inversely related to the mean number of gastric aspirates >/==" BORDER="0"> 100 mL/d (Spearman rho = -0.04; p = 0.06), but not to severity of illness, nutritional status, or route of feeding. After accounting for the number of gastric aspirates >/==" BORDER="0"> 100 mL, severity of illness, nutritional status, and route of feeding, tertile II of caloric intake (vs tertile I) was associated with a significantly greater likelihood of achieving spontaneous ventilation prior to ICU discharge. Tertile III of caloric intake (vs tertile I) was associated with a significantly lower likelihood of both hospital discharge alive and spontaneous ventilation prior to ICU discharge.
  
  
  CONCLUSIONS
  Study participants were underfed relative to ACCP targets. These targets, however, may overestimate needs, since moderate caloric intake (ie, 33 to 65% of ACCP targets; approximately 9 to 18 kcal/kg per day) was associated with better outcomes than higher levels of caloric intake.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Krishnan
authors.forename: Pat B
authors.initials: PB
authors.lastname: Parce
authors.forename: Anthony
authors.initials: A
authors.lastname: Martinez
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
authors.forename: Roy G
authors.initials: RG
authors.lastname: Brower
mesh_terms: D018806:APACHE; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D016638:Critical Illness; D002149:Energy Intake; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome