Significance: Although severity of illness is the single most important predictor of survival in critically ill patients, there are many questions about the contribution of other factors to patient outcomes. The purpose of this paper is to describe calorie intake variations in chronically critically ill (CCI) patients and its relationship to nutritional and clinical outcomes.
Methods: A prospective, longitudinal design was used to abstract data from the patient records of 400 adult patients who required >72 hours of long-term ventilation (LTV). Weekly data were collected while the subjects were hospitalized, for a total of 756 feeding days. Nutritional data reported are body mass index (BMI), serum albumin, prealbumin, hemoglobin, dieticians’ recommendations, physicians’ orders, and patients’ actual 24-hour caloric intake. Patient outcome data are survival status and length of time on mechanical ventilation.
Results: Inconsistencies among dieticians’ recommendations, physicians’ orders and nurses’ implementation resulted in wide variations in subjects’ calculated nutritional adequacy. Subjects received an average of 83% of the Kilocalories (Kcals) ordered by their physicians (SD=27%, range=0-200%) and 68% of the dieticians’ recommended Kcals (SD=33%, range=0-219%). For subjects who died (N=155), there were no statistically significant relationships between nutrition variables and length of mechanical ventilation. For survivors, BMI and three laboratory values (admission serum albumin and mean albumin and hemoglobin during hospitalization) explained 12% of variation in time on mechanical ventilation.
Conclusions: Multiple factors influence supplemental feeding practices in CCI patients. These practices result in both under and over-prescribing and under and over-feeding. Nurses need better information about organizational factors that affect nutrition management as well as the impact of nutritional adequacy on outcomes related to mechanical ventilation and discharge disposition. This study is supported by NINR05005.
Session #1077 - Acute Care Research: Impacting Patient Care Outcomes
The 29th Annual MNRS Research Conference (April 1-4, 2005)