PP154 - ASSOCIATION BETWEEN PROTEIN-ENERGY ADEQUACY, SEDATION INTERRUPTION, AND ICU DELIRIUM IN MECHANICALLY VENTILATED PATIENTS
PP154
ASSOCIATION BETWEEN PROTEIN-ENERGY ADEQUACY, SEDATION INTERRUPTION, AND ICU DELIRIUM IN MECHANICALLY VENTILATED PATIENTS
E. Diogou1,*, A. E. Zouridaki2, M. Avgoulea1, E. Papathanassiou1, A. Sakelliou1, M. Theodorakopoulou1,3
1ICU, General Hospital of Attiki KAT, Kifisia, Greece, 2School of Medicine, university of limerick, Limerick, Ireland, 3School of Medicine, National and Kapodistrian university of athens, Athens, Greece
Rationale: ICU delirium is a major determinant of worse outcomes in ICU patients. While sedation and daily sedation interruption are established components of delirium prevention, the contribution of adequate caloric and protein delivery remains insufficiently defined. We hypothesized that optimal protein-energy intake, combined with sedation interruption, is associated with reduced delirium incidence.
Methods: This prospective observational study included adult patients mechanically ventilated >48 hours in a mixed medical-surgical ICU. Daily energy and protein delivery were recorded for the first 7 ICU days and expressed as a % of prescribed targets. Delirium was assessed twice daily using CAM-ICU in patients with RASS≥ −3. Sedation vacations were applied when clinically feasible. Nutritional adequacy was defined as ≥70% of both energy and protein targets. Multivariable logistic regression adjusted for age, APACHE II score, sepsis, and cumulative sedative exposure.
Results: 132 patients, 58 (43.9%) developed delirium. Adequate nutrition was associated with lower delirium incidence (32.1% vs 55.8%, p=0.01). Higher protein delivery independently reduced delirium odds (adjusted OR 0.72 per 0.3 g/kg/day; 95% CI 0.55–0.94; p=0.02), whereas energy intake alone showed no independent effect. Daily sedation interruption was associated with shorter delirium duration and more delirium-free days. Patients receiving both adequate protein intake and sedation interruption had the lowest delirium burden, shorter mechanical ventilation, and reduced ICU stay.
Conclusion: Protein delivery, rather than caloric intake alone, is a key modifiable factor in ICU delirium. Combined with daily sedation interruption, adequate protein intake significantly reduces delirium burden and improves clinical outcomes. These findings support an integrated metabolic and sedation strategy to prevent delirium in critical care.
Disclosure of Interest: None declared