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. 2016 Dec;70(12):1443-1450.
doi: 10.1038/ejcn.2016.167. Epub 2016 Sep 14.

Relevance of non-nutritional calories in mechanically ventilated critically ill patients

E Bousie  1 , D van Blokland  1 , H J W Lammers  2 , A R H van Zanten  1
Affiliations

Relevance of non-nutritional calories in mechanically ventilated critically ill patients

E Bousie et al. Eur J Clin Nutr. 2016 Dec.

Abstract

Background/objectives: Overfeeding in critically ill patients is associated with many complications. Propofol, dextrose infusion and citrate dialysis provide non-nutritional calories (NNCs), potentially causing overfeeding. The relevance of NNCs for total caloric intake has not been systematically studied.

Subjects/methods: We retrospectively studied adult mechanically ventilated intensive care unit (ICU) patients receiving enteral nutrition with or without supplemental parenteral nutrition. Primary outcome was the proportion of NNCs (from dextrose, propofol and trisodium citrate) to the total energy intake during the first 7 days after ICU admission. In addition, NNC intake groups were compared.

Results: In total, we identified 146 patients: 142 patients with NNC median value of 580 kcal (interquartile range 310-1043 kcal) over 7 days and 4 patients without NNC intake. The mean proportion of NNCs was larger during the first days after ICU admission (30.7-36.1%), because of the start-up phase of the nutrition. In the 'propofol' group and the 'dextrose' group this proportion levelled off at 6% on day 4. A more stable proportion of 18% was found during the first 7 days of ICU admission in the 'citrate' group.

Conclusions: The mean proportion of NNCs in patients who receive dextrose and/or propofol is low (6%); however, in individual patients it may comprise one-third of the total daily calories. Patients receiving trisodium citrate have higher mean non-nutritional intakes (18%). As NNC intake can be marked in individual patients, close monitoring is warranted when administering high-dose propofol or trisodium citrate anticoagulation to prevent overfeeding.

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Conflict of interest statement

EB, DvB and HJWL declare no conflict of interest. Dr van Zanten reported that he has received honoraria for advisory board meetings, lectures and travel expenses from Abbott, Baxter, Braun, Danone-Nutricia, Fresenius Kabi and Nestle-Novartis. Inclusion fees for patients in nutrition trials were paid to the local ICU research foundation.

Figures

Figure 1
Figure 1
Proportions of nutritional and NNCs in the first 7 days of ICU admission. On the X axis, the day of ICU admission and the total of the first 7 days of admission, and on the Y axis, the calories from dextrose (blue), propofol (red), citrate (green) and nutrition (purple) of the total calories.
Figure 2
Figure 2
Absolute calories (nutritional and non-nutritional) of the first 7 days of ICU admission. On the X axis, the day of ICU admission and the mean of the first 7 days, and on the Y axis, the kcal per day from dextrose (blue), propofol (red), trisodium citrate (green) and nutrition (purple).
See this image and copyright information in PMC

References

    1. Barr J, Hecht M, Flavin KE, Khorana A, Gould MK. Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest 2004; 125: 1446–1457. - PubMed
    1. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr 2016; 40: 159–211. - PubMed
    1. McClave SA, Weijs PJ. Preservation of autophagy should not direct nutritional therapy. Curr Opin Clin Nutr Metab Care 2015; 18: 155–161. - PubMed
    1. Food and Agriculture Organization of the United Nations (2003). Food energy—methods of analysis and conversion factors—Annex IV. Available at: ftp://ftp.fao.org/docrep/fao/006/y5022e/y5022e00.pdf (last accessed 30 September 2015).
    1. Greenwood J. ICU Guideline: adjusting goal feed rates in the patients receiving propofol, 2009. Available at: http://www.criticalcarenutrition.com/docs/tools/Propofol.pdf (last accessed 28 September 2015).

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