Propofol use precludes prescription of estimated nitrogen requirements.
The objective was to determine whether reducing enteral nutrition to accommodate 1% Propofol-derived energy results in suboptimal nitrogen prescription. This was a prospective observational study of 85 consecutive patients requiring mechanical ventilation and receiving 1% Propofol. Enteral nutrition prescription often failed to meet nitrogen requirements (<90%, in 50.6%; <80%, in 21.1%), whereas fat provided 51% of total energy input, exceeding 2 g fat/kg/d in 20%. However, gastroparesis was common, resulting in suboptimal nutrition (median of requirements: energy 71%; nitrogen 57%). If energy balance had been strictly maintained, substituting 1% with 2% Propofol would reduce the number of patients failing to meet nitrogen requirements (1% vs 2%: <90%: in 58.8% vs 17.6%, P< .001; <80% in 35.3% vs 4.7%, P< .014). These effects are directly related to the amount of fat delivered with Propofol. Intensive care unit-associated gastroparesis commonly reduces enteral nutrition input. However, even where this is overcome, use of 1% Propofol frequently precludes prescription of estimated nitrogen requirements; either 2% Propofol or a non-Propofol alternative should be considered.
Taylor
Stephen J
SJ
Department of Nutrition and Dietetics, Frenchay Hospital, Bristol BS16 1LE, UK. dusk@gotadsl.co.uk
Bowles
Jon
J
Jewkes
Claire
C
D000328:Adult; D003627:Data Interpretation, Statistical; D002149:Energy Intake; D004734:Energy Metabolism; D004750:Enteral Nutrition; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism*; D009751:Nutritional Requirements; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D012121:Respiration, Artificial
D005217:Fat Emulsions, Intravenous; D006993:Hypnotics and Sedatives; D009584:Nitrogen; D015742:Propofol