Current practice in nutritional support and its association with mortality in septic patients--results from a national, prospective, multicenter study.
OBJECTIVE
To identify current clinical practice regarding nutrition and its association with morbidity and mortality in patients with severe sepsis or septic shock in Germany.


METHODS
Nationwide prospective, observational, cross-sectional, 1-day point-prevalence study.


METHODS
The study included 454 intensive care units from a representative sample of 310 hospitals stratified by size.


METHODS
Participants were 415 patients with severe sepsis or septic shock (according to criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference).


METHODS
None.


RESULTS
Data were collected by on-site audits of trained external study physicians during randomly scheduled visits during 1 yr. Valid data on nutrition were available for 399 of 415 patients. The data showed that 20.1% of patients received exclusively enteral nutrition, 35.1% exclusively parenteral nutrition, and 34.6% mixed nutrition (parenteral and enteral); 10.3% were not fed at all. Patients with gastrointestinal/intra-abdominal infection, pancreatitis or neoplasm of the gastrointestinal tract, mechanical ventilation, or septic shock were less likely to receive exclusively enteral nutrition. Median Acute Physiology and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment scores were significantly different among the nutrition groups. Overall hospital mortality was 55.2%. Hospital mortality was significantly higher in patients receiving exclusively parenteral (62.3%) or mixed nutrition (57.1%) than in patients with exclusively enteral nutrition (38.9%) (p = .005). After adjustment for patient morbidity (Acute Physiology and Chronic Health Evaluation II score, presence of septic shock) and treatment factors (mechanical ventilation), multivariate analysis revealed that the presence of parenteral nutrition was significantly predictive of mortality (odds ratio, 2.09; 95% confidence interval, 1.29-3.37).


CONCLUSIONS
Patients with severe sepsis or septic shock in German intensive care units received preferentially parenteral or mixed nutrition. The use of parenteral nutrition was associated with an increased risk of death.
Elke
Gunnar
G
Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Germany. elke@anaesthesie.uni-kiel.de
Schädler
Dirk
D
Engel
Christoph
C
Bogatsch
Holger
H
Frerichs
Inez
I
Ragaller
Maximilian
M
Scholz
Jens
J
Brunkhorst
Frank M
FM
Löffler
Markus
M
Reinhart
Konrad
K
Weiler
Norbert
N
D018806:APACHE; D000368:Aged; D019091:Critical Pathways; D003430:Cross-Sectional Studies; D004750:Enteral Nutrition / Q000401:mortality*; D005260:Female; D005858:Germany; D006276:Health Facility Size / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006769:Hospitals, General / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D010289:Parenteral Nutrition, Total / Q000401:mortality*; D011446:Prospective Studies; D012772:Shock, Septic / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate