title: Impact of energy deficit calculated by a predictive method on outcome in medical patients requiring prolonged acute mechanical ventilation.
abstract: To assess energy balance in very sick medical patients requiring prolonged acute mechanical ventilation and its possible impact on outcome, we conducted an observational study of the first 14 d of intensive care unit (ICU) stay in thirty-eight consecutive adult patients intubated at least 7 d. Exclusive enteral nutrition (EN) was started within 24 h of ICU admission and progressively increased, in absence of gastrointestinal intolerance, to the recommended energy of 125.5 kJ/kg per d. Calculated energy balance was defined as energy delivered - resting energy expenditure estimated by a predictive method based on static and dynamic biometric parameters. Mean energy balance was - 5439 (sem 222) kJ per d. EN was interrupted 23 % of the time and situations limiting feeding administration reached 64 % of survey time. ICU mortality was 72 %. Non-survivors had higher mean energy deficit than ICU survivors (P = 0.004). Multivariate analysis identified mean energy deficit as independently associated with ICU death (P = 0.02). Higher ICU mortality was observed with higher energy deficit (P = 0.003 comparing quartiles). Using receiver operating characteristic curve analysis, the best deficit threshold for predicting ICU mortality was 5021 kJ per d. Kaplan-Meier analysis showed that patients with mean energy deficit > or =5021 kJ per d had a higher ICU mortality rate than patients with lower mean energy deficit after the 14th ICU day (P = 0.01). The study suggests that large negative energy balance seems to be an independent determinant of ICU mortality in a very sick medical population requiring prolonged acute mechanical ventilation, especially when energy deficit exceeds 5021 kJ per d.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Réanimation Médicale, 20 rue Leblanc, 75908, Paris, France. christophe.faisy@egp.aphp.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Faisy
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lerolle
authors.forename: Fahmi
authors.initials: F
authors.lastname: Dachraoui
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Savard
authors.forename: Imad
authors.initials: I
authors.lastname: Abboud
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Tadie
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Fagon
mesh_terms: D000208:Acute Disease; D000368:Aged; D003422:Critical Care; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009751:Nutritional Requirements; D009752:Nutritional Status; D011379:Prognosis; D012121:Respiration, Artificial / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome