PW03 - NUTRITION THERAPY AROUND EXTUBATION IN CRITICALLY ILL PATIENTS, PRELIMINARY RESULTS FROM THE ANEXT TRIAL.

PW03

NUTRITION THERAPY AROUND EXTUBATION IN CRITICALLY ILL PATIENTS, PRELIMINARY RESULTS FROM THE ANEXT TRIAL.

L. Heeren^1,*, L. De Hart², J. Jonckheer¹

¹intensive care, ²clinical nutrition, Universitair Ziekenhuis Brussel, Jette, Belgium

Rationale: Nutrition therapy is challenging in the intensive care unit. Several issues preclude nutrition adequacy. Extubation is known to be a risk factor for malnutrition due to patient- and healthcare providers barriers. Following extubation, patients suffer from dysphagia, poor appetite and nausea which hamper adequate nutrient intake. Additionally, a common misconception is that the patient will be eating in sufficient amounts after extubation, leaving the patient without medical nutrition therapy. Therefore, even when (parenteral) medical nutrition is available, individual needs are not met. However, the available data on this topic is outdated and nutrition practices have evolved.  

Methods: ANEXT is a prospective observational trial to evaluate how nutrition adequacy changes around the period of extubation in UZBrussel, a tertiary hospital in Brussels, Belgium. Adult patients admitted to the ICU and intubated for more than three days were included. Nutrition and non-nutritional energy were recorded as from two days before presumed extubation until five days after extubation.

The study was approved by the Comitee Medische Ethiek(O.G. 016) with B.U.N.1432024000161. Data were collected with Redcap and analyzed with GraphPad Prism 10.5.0. Data are expressed as mean ± standard deviation. T-test was used for comparison between 2 groups and one-way Anova was used for comparison between multiple groups.  

Results: This is a pre-planned intermediate analysis of 8 patients. Mean APACHE II score was 24 ±7 with a NUTRIC score of 6 ± 2 . Mean age was 60 ± 21 years with a BMI of 27 ± 5 kg/m². All patients  were men. The mean ventilation time was 11 ± 5 days. Energy and protein adequacy (n=8) were 54 ± 30% and 49 ± 31% respectively the day before extubation and were 68 ± 32% and 63 ± 22% respectively the first day after extubation (n=8). Adequacy evolved over time as follows: 95 ± 24% and 94 ± 29% on day 2 (n=8), 76 ± 27% and 70 ± 27% on day 3 (n=7), 62 ± 32% and 51 ± 24% on day 4 (n=4) and 71 ± 35% and 58 ± 28% on day 5 (n=4), respectively. One-way Anova showed no statistical significant difference for energy adequacy (p=0,226) but  did show statistical significance for protein adequacy (p<0,05). Energy and protein adequacy were not statistically significantly different between the day before and the day after extubation (p=0,48 and p = 0,52 respectively). Only one patient started eating on day 3 after extubation, all other patients received solely medical nutrition.

Conclusion: Nutrition adequacy remains challenging in the ICU. Extubation did not change adequacy. Nutrition support with an elaborated nutrition plan is crucial around extubation as only one patient had sufficient autonomous oral feeding. Further analysis of all pre-planned subjects is needed to confirm our findings.

Disclosure of Interest: None declared