PP056 - NUTRITION INADEQUACY DURING PARENTERAL TO ENTERAL NUTRITION TRANSITION IN INDIAN ICUS: INSIGHTS FROM EXPERT, EVIDENCE AND EXPERIENCE (EEE) MEETINGS
PP056
NUTRITION INADEQUACY DURING PARENTERAL TO ENTERAL NUTRITION TRANSITION IN INDIAN ICUS: INSIGHTS FROM EXPERT, EVIDENCE AND EXPERIENCE (EEE) MEETINGS
R. Reddy Chada1, H. Dev2, B. Samant3, M. N. Shivakumar4,*, A. Chattopadhyay5, E. Canday6, V. Gorey7, G. Thangaraj8, V. Nagarajan9, R. Dey10, A. K. A. S.11, C. Chakravarty12, S. Sonawale13, N. Joshi13
1Dietetics, AIG Hospital, Hyderabad, 2Critical Care, Apollo Hospital, Bangalore, 3Dietetics, Kokilaben Dhirubai Ambani Hospital, Mumbai, 4Critical Care, Royal Care Hospitals, Coimbatore, 5Critical Care, CMRI Hospital, Kolkata, 6Dietetics, Sir H. N. Reliance Foundation Hospital, Mumbai, 7Dietetics, Apollo Hospital, Navi Mumbai, 8Critical Care, Kovai Medical Center & Hospital, Coimbatore, 9Dietetics, MGM Healthcare, Chennai, 10Critical Care, Ruby General Hospital, Kolkata, 11Critical Care, Aster MIMS Hospital, Calicut, 12Critical Care, Manipal Hospital, Kolkata, 13Medical & Scientific Affairs, Dr. Reddy's & Nestle Health Science, Mumbai, India
Rationale: The transition from Parenteral Nutrition (PN) to Enteral Nutrition (EN) is a vulnerable phase in ICU care. Patients often receive only ~60–70% of prescribed nutrition, with an additional 10-30% drop during transition.1,2 Real world data from Indian ICUs remain limited.
Methods: A structured poll was conducted during 13 EEE Transition Nutrition meetings across India, involving 329 ICU professionals - dietitians and intensivists. Data on PN indications, initiation timing, transition triggers, overlap practices, and calorie and protein deficits were collected and analysed using descriptive statistics.
Results: PN use was selective, with over 70% of respondents reporting that fewer than 10% of patients received PN on any given day. Its use was primarily driven by a non-functional GI tract (77%), followed by severe malabsorption (56%) and inability to meet nutritional targets with EN alone (46%). In cases of EN intolerance, PN initiation was most commonly reported at 3–5 days of ICU admission (38%), followed closely by 2–3 days (34%), reflecting a condition-based escalation approach. Transition back to EN was also largely guided by clinical status, with 78% initiating PN-to-EN transition upon restoration of GI function. During the transition phase, 57% reported overlapping PN and EN in 11–20% of patients. This practice was associated with risks such as fluid overload (54%), overfeeding (42%), and enteral feeding intolerance (31%). Nutritional deficits remained prevalent, with ~47% of respondents reporting a 11–30% reduction in calorie and protein delivery.
Conclusion: PN-to-EN transition in Indian ICUs require structured strategies, including graded EN advancement, careful PN tapering and close monitoring of nutritional delivery to improve adequacy during this critical phase.
References: 1. Singer P, et al. Clin Nutr. 2019;38:48–79.
2. Heyland DK, et al. Crit Care Med. 2015
Disclosure of Interest: None declared