Sep 13, 2025
1:00 PM2:00 PM
Poster Session
P053 - DEVELOPMENT OF AN INSTITUTIONAL PROTOCOL FOR NITROGEN BALANCE APPLICATION IN CRITICALLY ILL PATIENTS
P053
DEVELOPMENT OF AN INSTITUTIONAL PROTOCOL FOR NITROGEN BALANCE APPLICATION IN CRITICALLY ILL PATIENTS
C. Valverde Pereira1,*, S. R. Ramos1, L. Kagueyama1, E. Suiter1, S. R. Machado1, A. N. Severine1
1Hospital Sírio-Libanês, São Paulo, Brazil
Rationale: Nitrogen balance(NB)assesses protein equilibrium in critically ill patients and is influenced by multiple factors1.Accurate results and standardized protocols are vital for appropriate nutritional support.
Methods: An integrative literature review was conducted using PubMed and LILACS databases from the past 10years.Criteria for NB application were defined, including patient selection,timing, method,calculation and interpretation.The protocol was adapted for ICU use.
Results: NB calculation requires nitrogen(N)intake over 24 hours,assuming 16% N in protein.Hypercatabolic states:[Urinary Urea Nitrogen(UUN)(g)÷0.85+Insensible Losses(g)],with insensible losses.Recovery Phase:[UUN(g)+4(g/day)],assuming fixed losses2.Additional losses:Burn injuries:(+0.1×BSA×%TBSA open wound×100)3;Fever:(+0.6g N per degree above 37.5°C)4;Serum Urea Nitrogen (SUN) variation:(+{Total Body Water×Daily Weight×[(Final SUN–Initial SUN)×0.01]})1.NB values -4 and +4 are adequate in hypercatabolic states and ≥0 in recovering5.Protein deficit compensation: NB Result×6.25+4g.
Conclusion: Standardizing collection and analysis methods is crucial to enhance NB application in clinical practice.
References: 1.SingerP,et al.Feasibility of achieving different protein targets using a hypocaloric high-protein enteral formula in critically ill patients.Crit Care.2021Jun 11;25(1).2.BlackburnGL,et al.Nutritional and metabolic assessment of the hospitalized patient. JPEN JParenter Enteral Nutr.1977;1(1).3.Waxman K,et al.Protein loss across burn wounds.JTrauma.1987 Feb;27(2).4.Parenteral and Enteral Nutrition Group of the British Dietetic Association.A pocket guide to clinical nutrition.4th ed.Birmingham:British Dietetic Association;2011.5.Dickerson RN,et al.Augmented Renal Clearance Following Traumatic Injury in Critically Ill Patients Requiring Nutrition Therapy.Nutrients.2021May;15(5).
Disclosure of Interest: None declared