Current clinical nutrition practices in critically ill patients in Latin America: a multinational observational study

Abstract

Background: Malnutrition in critically ill adults in the intensive care unit (ICU) is associated with a significantly elevated risk of mortality. Adequate nutrition therapy is crucial to optimise outcomes. Currently, there is a paucity of such data in Latin America. Our aims were to characterise current clinical nutrition practices in the ICU setting in Latin America and evaluate whether current practices meet caloric and protein requirements in critically ill patients receiving nutrition therapy.

Methods: We conducted a cross-sectional, retrospective, observational study in eight Latin American countries (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Panama, and Peru). Eligible patients were critically ill adults hospitalised in the ICU and receiving enteral nutrition (EN) and/or parenteral nutrition (PN) on the Screening Day and the previous day (day -1). Caloric and protein balance on day -1, nutritional status, and prescribed nutrition therapy were recorded. Multivariable logistic regression analysis was performed to identify independent predictors of reaching daily caloric and protein targets.

Results: The analysis included 1053 patients from 116 hospitals. Evaluation of nutritional status showed that 74.1% of patients had suspected/moderate or severe malnutrition according to the Subjective Global Assessment. Prescribed nutrition therapy included EN alone (79.9%), PN alone (9.4%), and EN + PN (10.7%). Caloric intake met >90% of the daily target in 59.7% of patients on day -1; a caloric deficit was present in 40.3%, with a mean (±SD) daily caloric deficit of -688.8 ± 455.2 kcal. Multivariable logistic regression analysis showed that combined administration of EN + PN was associated with a statistically significant increase in the probability of meeting >90% of daily caloric and protein targets compared with EN alone (odds ratio, 1.56; 95% confidence interval, 1.02-2.39; p = 0.038).

Conclusions: In the ICU setting in Latin America, malnutrition was highly prevalent and caloric intake failed to meet targeted energy delivery in 40% of critically ill adults receiving nutrition therapy. Supplemental administration of PN was associated with improved energy and protein delivery; however, PN use was low. Collectively, these findings suggest an opportunity for more effective utilisation of supplemental PN in critically ill adults who fail to receive adequate nutrition from EN alone.

Keywords: Caloric balance; Disease-related malnutrition; Enteral nutrition; Intensive care; Parenteral nutrition.

Fig. 1

Study design. *Available data from patient records collected for each day of stay in the ICU during the period from day –5 to day –2. ^†NUTRIC score calculated based on data in the patients’ medical file collected at the time of ICU admission. ^‡Calculated as the difference between the daily caloric target and the daily calories provided by enteral and/or parenteral nutrition plus other sources of caloric intake. ^¶Calculated as the difference between the clinician-derived daily protein target and the daily protein intake. Abbreviations: ESPEN European Society for Clinical Nutrition and Metabolism, NUTRIC nutrition risk in the critically ill, SD Screening Day, SGA Subjective Global Assessment

Fig. 2

Daily caloric balance based on a clinician-derived daily target and b standardised daily target*. *Defined as the difference between the daily caloric target and the sum of calories from enteral and/or parenteral nutrition and other sources of caloric intake

Fig. 3

Proportion of patients with caloric deficit on day –1 according to prescribed nutritional therapy. Abbreviations: EN enteral nutrition, PN parenteral nutrition

Fig. 4

Mean (±SD) cumulative caloric balance in patients who did not meet the cumulative caloric target*. *Defined as the sum of the mean daily caloric balance for all days from day −1, calculated for each day from day −5 to day −1

Fig. 5

Mean (±SD) cumulative protein balance in patients who did not meet the cumulative protein target*. *Defined as the sum of the mean daily protein balance for all days from day −1, calculated for each day from day −5 to day −1