Introduction
Nutrition therapy is an integrant aspect of ICU support and can influence outcomes. A delay to starting nutrition support after 24 hours of ICU admission is associated with increased morbidity and mortality [1], and certain lipid emulsions can exacerbate the inflammatory cascade. For an appropriate evaluation of the impact of these and other recent research findings, information regarding the use of parenteral nutrition (PN) in the ICU is needed.
Methods
This is the interim analysis of a multicenter, prospective, cohort study aimed to obtain information regarding the use of PN. Data were collected during 3 months from ICU patients over 18 years of age on the use of PN in 20 adult ICUs in Brazil using a web-based clinical research form.
Results
One hundred and sixty-six patients were included in this analysis. Among the main results, 63.69% were males and 77.78% were considered malnourished. The mean SOFA score was 6.21, with a mean APACHE II score of 19.39. In total, 97.23% of the PN used in Brazil were manufactured by third-party companies and this was associated with a significant delay in the beginning of the infusion (median time 29.76 hours), and elevated in-ICU (50%) and inhospital (55.17%) mortality rates. A total 24.29% of the patients were immunosuppressed. The most used lipid source was long-chain triglycerides/medium-chain triglycerides (80.69%).
Conclusion
The use of PN in Brazil is associated with a significant delay in the start of infusion and high mortality rates. The most used lipid emulsion (long-chain triglycerides/medium-chain triglycerides) has been associated with more apoptosis [2] and compromised lymphocyte proliferation [3]. The overall findings of these study indicate that strategies to reduce the delay in start of PN and the use of better lipid sources must be adopted to provide better assistance for patients in need of PN in Brazil.
Acknowledgements
Supported by a research grant from Baxter Hospitalar Ltda.
References
- Simpson F, Doig GS. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med. 2005;11:12–23. doi: 10.1007/s00134-004-2511-2. [DOI] [PubMed] [Google Scholar]
- Buenestado A, Cortijo J, Sanz M-J. et al. Olive oil-based lipid emulsion' s neutral effect on neutrophil functions and leucocyte–endothelial cell interactions. J Parenter Enteral Nutr. 2006;11:286–296. doi: 10.1177/0148607106030004286. [DOI] [PubMed] [Google Scholar]
- Cury-Boaventura M, Gorjão R, Martins de Lima T, Toxicity of two lipid emulsions on human lymphocytes and neutrophils. Crit Care. in press .