title: Low energy intake during the first week in an emergency intensive care unit is associated with reduced duration of mechanical ventilation in critically ill, underweight patients: a single-center retrospective chart review.
abstract: BACKGROUND
  Although nutrition support is essential in intensive care units, optimal energy intake remains unclear. Here, we assessed the influence of energy intake on outcomes of critically ill, underweight patients.
  
  
  METHODS
  A retrospective chart review was conducted in patients with body mass index (BMI) of <20.0 kg/m(2) in an emergency intensive care unit (EICU). Patients were categorized into 4 groups by initial Sequential Organ Failure Assessment score (I-SOFA) and average daily energy intake during the first week: group M-1, I-SOFA ≤8 and <16 kcal/kg/d; group M-2, I-SOFA ≤8 and ≥16 kcal/kg/d; group S-1, I-SOFA >8 and <16 kcal/kg/d; and group S-2, I-SOFA >8 and ≥16 kcal/kg/d.
  
  
  RESULTS
  The study included 51 patients with a median age of 69 years. No significant differences were noted in all-cause mortality and length of stay in the EICU and hospital between groups M-1 and M-2 or groups S-1 and S-2. The mechanical ventilation duration (MVD) was significantly shorter in group M-1 than M-2 (2.7 [1.0-5.7] vs 9.2 [4.2-17.4] days; P = .040) and in group S-1 than S-2 (3.1 [0.7-6.0] vs 8.8 [6.1-23.1] days; P = .006). The number of patients who underwent tracheostomy in hospital was significantly lower in group S-1 than in S-2 (20% vs 32%; P = .002). Multivariable analyses to adjust for confounders revealed that average energy intake during the first week in EICU was a significant factor independently associated with MVD but not with the requirement of tracheostomy.
  
  
  CONCLUSIONS
  Reduced energy intake during the first week in EICU was associated with a reduced MVD in clinically ill patients with BMI <20.0 kg/m(2).
authors.affiliation: Department of Nutrition Management, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Satomi
authors.initials: S
authors.lastname: Ichimaru
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Teruyoshi
authors.initials: T
authors.lastname: Amagai
authors.forename: Takahiro
authors.initials: T
authors.lastname: Atsumi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018529:Nutritional Support; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D013851:Thinness / Q000628:therapy
keywords: artificial respiration; body mass index; critical illness; critically ill; emergency intensive care unit; energy intake; energy metabolism; intensive care units; mechanical ventilation; underweight