Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients.
OBJECTIVE
Critically ill patients with complicated evolution are frequently hypermetabolic, catabolic, and at risk of underfeeding. The study aimed at assessing the relationship between energy balance and outcome in critically ill patients.


METHODS
Prospective observational study conducted in consecutive patients staying > or = 5 days in the surgical ICU of a University hospital. Demographic data, time to feeding, route, energy delivery, and outcome were recorded. Energy balance was calculated as energy delivery minus target. Data in means+/-SD, linear regressions between energy balance and outcome variables.


RESULTS
Forty eight patients aged 57+/-16 years were investigated; complete data are available in 669 days. Mechanical ventilation lasted 11+/-8 days, ICU stay 15+/-9 was days, and 30-days mortality was 38%. Time to feeding was 3.1+/-2.2 days. Enteral nutrition was the most frequent route with 433 days. Mean daily energy delivery was 1090+/-930 kcal. Combining enteral and parenteral nutrition achieved highest energy delivery. Cumulated energy balance was between -12,600+/-10,520 kcal, and correlated with complications (P < 0.001), already after 1 week.


CONCLUSIONS
Negative energy balances were correlated with increasing number of complications, particularly infections. Energy debt appears as a promising tool for nutritional follow-up, which should be further tested. Delaying initiation of nutritional support exposes the patients to energy deficits that cannot be compensated later on.
Villet
Stéphane
S
Anesthésiologie, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland.
Chiolero
René L
RL
Bollmann
Marc D
MD
Revelly
Jean-Pierre
JP
Cayeux R N
Marie-Christine
MC
Delarue
Jacques
J
Berger
Mette M
MM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome