PD437 - NUTRITIONAL SUPPORT INITIATION PATTERNS IN ACUTE NEUROLOGICAL PATIENTS: ARE WE FOLLOWING ESPEN GUIDELINES?

PD437

NUTRITIONAL SUPPORT INITIATION PATTERNS IN ACUTE NEUROLOGICAL PATIENTS: ARE WE FOLLOWING ESPEN GUIDELINES?

H. Mo^1,*, D. W. Shin², D.-H. Ko³, S. B. An²

¹Neurology, Inha University Hospital, Incheon, ²Surgery, ³Internal medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea, Republic Of

Rationale: Malnutrition and dysphagia are common in critically ill neurological patients and are associated with poor outcomes. The ESPEN guideline recommends early dysphagia screening, initiation of enteral nutrition (EN) within 48 hours in patients unable to eat, and prioritization of EN over parenteral nutrition (PN). However, real-world adherence in Neuro-ICU settings remains unclear, particularly in Asian populations.

Methods: This single-center retrospective study included adult patients admitted to a Neuro-ICU in South Korea (January–December 2024). Patients aged <18 years or with ICU stay <48 hours were excluded. Data included baseline characteristics, admission albumin, dysphagia screening timing, EN/PN initiation, caloric intake, and clinical outcomes (in-hospital mortality, length of stay, aspiration pneumonia). Adherence to ESPEN recommendations was assessed in four domains: dysphagia screening ≤48 h, EN initiation ≤48 h, EN-first strategy, and achievement of 20–25 kcal/kg/day. Statistical analyses were performed using SPSS 27.0, with p<0.05 considered significant.

Results: A total of 251 patients were included (63.0% male; mean age 67.8 years). Sixty-five patients (25.9%) did not receive EN within 48 hours and had more severe neurological deficits with clinical deterioration after admission. Mortality was markedly higher in this group (83.1%) compared to those who received early EN (12.4%, n=186).

Conclusion: Early EN was not implemented in approximately one-quarter of patients, indicating gaps between guideline recommendations and practice. Early EN was associated with lower mortality, highlighting the need to address barriers and improve adherence to nutritional guidelines in critically ill neurological patients.

References: P. Singer et al., ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr. 2023 Sep;42(9):1671-1689.

Disclosure of Interest: None declared