Are we feeding our critically ill patients appropriately?

Abstract

Introduction: Nutrition plays a significant part in the overall treatment plan for critically ill patients. In India, there are varying practices including use of kitchen feeds and/or commercial formula and also predominant use of bolus feeds. The multidisciplinary team in our critical care unit (CCU) includes a senior dietician and we wanted to review whether our standardized practice of routine screening for malnutrition using subjective global assessment, early use of nutrition (preferably within 24 hours) and continuous enteral feeding using commercial formula helped achieve nutritional goals. Methods: A retrospective chart review was conducted on 508 patients who received continuous enteral feeding on day 1 and day 5 of the ICU stay. Information on calories prescribed (using the Harris-Benedict equation) and delivered on day 1 and day 5 was collected. Achieving the nutritional goal was defined as successful delivery of 90% of prescribed calories. Data were analyzed using SPSS software and standard statistical methods. Results: On day 1, 37.6% of patients achieved delivery of caloric goals, and on day 5, this increased to 67.3%. Fluid restriction was the single most common reason for not meeting caloric goals both on days 1 and 5. Conclusions: Despite the availability of a clinical dietician and standardized nutritional practice, compliance of achieving caloric goals is low. Commercial formulas with a maximum of 2 kcal/ml are available in India, unlike the West where more calorie-dense formulas (up to 4.5 to 5 kcal/ ml) are available. Availability of these higher calorie dense commercial formulas may help increase our rates of achieving nutritional goals as fluid restriction appears to be the single most common limiting factor.