title: Nurse to bed ratio and nutrition support in critically ill patients.
abstract: BACKGROUND
  Inadequate nutrition support is common among critically ill patients, and identification of risk factors for such inadequacy might help in improving nutrition support.
  
  
  OBJECTIVE
  To determine how often daily calorie goals are met and the factors responsible for inadequate nutrition support. Methods A single-center prospective cohort study. Each patient's demographic and clinical characteristics, the need for ventilatory support, the use and dosage of medications, the number of nursing staff per bed, the time elapsed from admission to the intensive care unit until the effective start of enteral feeding, and the causes for nonadministration were recorded. Achievement of daily calorie goals was determined and correlated with risk factors.
  
  
  RESULTS
  A total of 262 daily evaluations were done in 40 patients. Daily calorie goal was achieved in only 46.2% of the evaluations (n = 121), with a mean of 74.8% of the prescribed volume of enteral nutrition infused daily. Risk factors for inadequate nutrition support were the use of midazolam (odds ratio, 1.58; 95% CI, 1.18-2.11) and fewer nursing professionals per bed (odds ratio, 2.56; 95% CI, 1.43-4.57). Conclusion Achievement of daily calorie goals was inadequate, and the main factors associated with this failure were the use and dosage of midazolam and the number of nurses available.
authors.affiliation: Most of the authors are employed in the Anesthesiology, Pain, and Intensive Care Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil: Carolina Keiko Yamamoto Honda, Flávio Geraldo Rezende Freitas, and Bruno Franco Mazza are physicians, Isac Castro is a statistician, and Ana Paula Metran Nascentev, Antonio Toneti Bafi, Luciano Cesar Pontes Azevedo, and Flávia Ribeiro Machado are physicians. Patricia Stanich is a nutritionist at Hospital Sao Paulo, Sao Paulo, SP, Brazil.
authors.forename: Carolina Keiko Yamamoto
authors.initials: CK
authors.lastname: Honda
authors.forename: Flávio Geraldo Rezende
authors.initials: FG
authors.lastname: Freitas
authors.forename: Patricia
authors.initials: P
authors.lastname: Stanich
authors.forename: Bruno Franco
authors.initials: BF
authors.lastname: Mazza
authors.forename: Isac
authors.initials: I
authors.lastname: Castro
authors.forename: Ana Paula Metran
authors.initials: AP
authors.lastname: Nascente
authors.forename: Antonio Toneti
authors.initials: AT
authors.lastname: Bafi
authors.forename: Luciano Cesar Pontes
authors.initials: LC
authors.lastname: Azevedo
authors.forename: Flávia Ribeiro
authors.initials: FR
authors.lastname: Machado
mesh_terms: D018806:APACHE; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D016638:Critical Illness / Q000451:nursing* / Q000628:therapy; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005283:Fentanyl / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008874:Midazolam / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000592:standards / Q000600:supply & distribution*; D018529:Nutritional Support / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D010665:Phenylpropanolamine / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D013566:Sympathomimetics / Q000009:adverse effects / Q000627:therapeutic use; D014147:Tramadol / Q000009:adverse effects / Q000627:therapeutic use; D000078329:Workforce; D016526:Workload / Q000592:standards / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D013566:Sympathomimetics; D010665:Phenylpropanolamine; D014147:Tramadol; D008874:Midazolam; D005283:Fentanyl