PD224 - ARE WE FOLLOWING ESPEN ICU GUIDELINES FOR ENERGY DELIVERY, USING INDIRECT CALORIMETRY IN THE ICU?

PD224

ARE WE FOLLOWING ESPEN ICU GUIDELINES FOR ENERGY DELIVERY, USING INDIRECT CALORIMETRY IN THE ICU?

C. O' Keeffe¹, M. Richardson^1,*, S. Ó Riain²

¹Department of Dietetics, ²ICU Department, University Hospital Limerick, Limerick, Ireland

 

Rationale: To compare energy intake with indirect calorimetry (IC) measurements. When IC is used, full nutrition can be progressively implemented after the early phase of acute illness. Full energy expenditure should not be the target during the early acute phase.^1,2 

Methods: Data was retrospectively collected over the first year of IC use from our Intensive Care Unit (ICU) computer system and indirect calorimeter. All ventilated patients who had IC completed were included. Excel was used for data analysis. Actual daily energy intake was compared to the last indirect calorimeter measurement.

Results: 125 IC tests were included. 
The below table shows the daily percentage requirement met (N=501 days).

	Day 3 ICU, n=19	Day 4-6  ICU, n=107	Day 7 ICU onwards, n= 375
Median %	55	87	99
Min %	23	18	6
Max %	113	116	138

On day 3 ICU, the average daily requirements met was 61% (n=19) and 79% (n=107) from day 4-6. From day 7 onwards, an average of 95% (n=375) of daily requirements were met.

From day 7 onwards, 57% (n=212) of the nutritional support days met 95-105% of energy requirements. 33% (n=124) of the nutritional support days met <95% of energy requirements and 10% (n=39) of the nutritional support days met >105% of energy requirements.

The main reasons the daily percentage requirements were not met, included potential endogenous calories during the acute phase of critical care, refeeding risk and GI issues such as vomiting & high aspirates.

Conclusion: The average and median of daily percentage requirements met, are in line with ESPEN guidelines. However, the minimum and maximum levels indicate that under and over feeding still occurs.

References:  

1. Singer et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clinical Nutrition 42 (2023) 1671-1689. 

2. Singer at al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition 38 (2019) 48-79. 

Disclosure of Interest: None declared