title: Nutrient delivery in mechanically ventilated surgical patients in the pediatric critical care unit.
abstract: OBJECTIVE
  Inadequate nutrient intake is associated with poor outcomes in critically ill children. We examined macronutrient delivery in surgical patients in the pediatric intensive care unit (PICU).
  
  
  METHODS
  In a prospective international cohort study of mechanically ventilated children (1month to 18years), we recorded adequacy of cumulative nutrient delivery in the PICU. Surgical patients enrolled in this study were included in the current analysis. Protein intake <60% of the prescribed goal was deemed inadequate.
  
  
  RESULTS
  Five hundred nineteen surgical patients, 45% female, median age 2years (IQR 0.5, 8), BMI z score -0.26, with 9-day median PICU stay and 60-day mortality 5.8% were enrolled. Three hundred forty-one (66%) patients received enteral nutrition (EN), and median time of initiation was PICU day 2. EN delivery was interrupted in 68% of these patients for a median duration of 9hours. Median enteral protein delivery was <15% of the prescribed goal and was <60% in two-thirds of the cohort. Patients with inadequate enteral protein delivery had longer time to EN initiation (p<0.001) and longer duration of EN interruptions (p<0.001) compared to those with adequate delivery.
  
  
  CONCLUSIONS
  Enteral protein delivery in critically ill pediatric surgical patients is inadequate. Early EN initiation and minimizing interruptions may increase protein delivery and potentially improve outcomes in this population.
  
  
  METHODS
  I.
  
  
  METHODS
  Prospective study.
authors.affiliation: Department of Surgery, Boston Children's Hospital; Harvard Medical School, Boston, MA 02115.
authors.forename: Cristine S
authors.initials: CS
authors.lastname: Velazco
authors.affiliation: Department of Surgery, Boston Children's Hospital; Division of Critical Care Medicine; Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital; Harvard Medical School, Boston, MA 02115.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Surgery, Boston Children's Hospital; Harvard Medical School, Boston, MA 02115.
authors.forename: Brenna S
authors.initials: BS
authors.lastname: Fullerton
authors.affiliation: Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Bechard
authors.affiliation: Department of Surgery, Boston Children's Hospital; Harvard Medical School, Boston, MA 02115.
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
authors.affiliation: Division of Critical Care Medicine; Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital; Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital; Harvard Medical School, Boston, MA 02115. Electronic address: nilesh.mehta@childrens.harvard.edu.
authors.forename: Nilesh M
authors.initials: NM
authors.lastname: Mehta
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial; D013997:Time Factors
keywords: Enteral nutrition; Interruption; PICU; Protein; Surgical