PP345 - FROM PRESCRIPTION TO DELIVERY: A PROSPECTIVE AUDIT OF NUTRITIONAL ADEQUACY IN THE ICU

PP345

FROM PRESCRIPTION TO DELIVERY: A PROSPECTIVE AUDIT OF NUTRITIONAL ADEQUACY IN THE ICU

E. Diogou^1,*, A. E. Zouridaki², E. Christopoulou¹, K. Karkoulias¹, K. Kostoulas¹, M. Theodorakopoulou^1,3

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: Adequate nutrition is a cornerstone of critical care. However, discrepancies between prescribed and delivered nutrition are common in ICU patients, potentially compromising recovery and increasing complications. Identifying gaps and modifiable factors is essential to improve outcomes. This study audited nutritional adequacy in a large ICU cohort and evaluated predictors of underfeeding.

Methods: We conducted a prospective observational study in a mixed medical-surgical ICU. Adult patients expected to require mechanical ventilation >48 hours were included. Daily caloric and protein prescriptions and actual intake were recorded for the first 7 ICU days. Nutritional adequacy was calculated as the ratio of delivered to prescribed nutrition (%). Interruptions, intolerance, procedures, and sedation were recorded. Patients achieving ≥80% of both prescribed calories and protein were considered adequately fed. Logistic regression identified predictors of underfeeding.

Results: Among 300 patients, median daily caloric delivery was 72% (IQR 60–85%) and protein delivery 68% (IQR 55–80%) of prescribed. Only 36% achieved ≥80% of both. Interruptions for procedures (34%), feeding intolerance (28%), and high sedation (22%) were common causes. High sedation (OR 2.1; 95% CI 1.2–3.7), prone positioning (OR 1.9; 95% CI 1.1–3.5), and frequent procedures (OR 2.4; 95% CI 1.3–4.5) were independent predictors of underfeeding. Notably, patients on combined enteral and parenteral nutrition received closer to target nutrition, whereas patients with prolonged interruptions had the largest gaps between prescribed and delivered intake.

Conclusion: A significant gap exists between prescribed and delivered nutrition in the ICU. Sedation, procedures, and feeding intolerance are modifiable factors. Strategies to reduce interruptions and optimize delivery are essential to improve metabolic support and patient outcomes.

Disclosure of Interest: None declared