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(Chest. 2003;124:297-305.)
© 2003 American College of Chest Physicians

Caloric Intake in Medical ICU Patients*

Consistency of Care With Guidelines and Relationship to Clinical Outcomes

Jerry A. Krishnan, MD; Pat B. Parce, RN; Anthony Martinez, MD; Gregory B. Diette, MD, MHS and Roy G. Brower, MD

* From the Division of Pulmonary and Critical Care Medicine (Drs. Krishnan, Diette, and Brower), Johns Hopkins University School of Medicine, Baltimore, MD; and St. Agnes HealthCare (Ms. Parce and Dr. Martinez), Baltimore, MD.

Correspondence to: Jerry A. Krishnan, MD, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Rm 4B.74, Baltimore, MD 21224; e-mail: jkrishn2{at}jhmi.edu

Study objectives: To assess the consistency of caloric intake with American College of Chest Physicians (ACCP) recommendations for critically ill patients and to evaluate the relationship of caloric intake with clinical outcomes.

Design: Prospective cohort study.

Setting: Adult ICUs at two teaching hospitals.

Participants: Patients with an ICU length of stay of at least 96 h.

Measurements and results: On ICU admission, severity of illness (ie, simplified acute physiology score II) and markers of nutritional status (ie, serum albumin level and body mass index) were recorded. The route of feeding (ie, enteral or parenteral), actual caloric intake (ie, percentage of ACCP recommendations: 0 to 32% [tertile I]; 33 to 65% [tertile II]; >= 66% [tertile III]), and evidence of GI intolerance (ie, gastric aspirate levels, >= 100 mL) were recorded daily. The following outcomes were assessed: status on hospital discharge (alive vs dead); spontaneous ventilation before ICU discharge (yes vs no); and ICU discharge without developing nosocomial sepsis (yes vs no). The average caloric intake among 187 participants was 50.6% of the ACCP targets and was similar in both hospitals. Caloric intake was inversely related to the mean number of gastric aspirates >= 100 mL/d (Spearman {rho} = -0.04; p = 0.06), but not to severity of illness, nutritional status, or route of feeding. After accounting for the number of gastric aspirates >= 100 mL, severity of illness, nutritional status, and route of feeding, tertile II of caloric intake (vs tertile I) was associated with a significantly greater likelihood of achieving spontaneous ventilation prior to ICU discharge. Tertile III of caloric intake (vs tertile I) was associated with a significantly lower likelihood of both hospital discharge alive and spontaneous ventilation prior to ICU discharge.

Conclusions: Study participants were underfed relative to ACCP targets. These targets, however, may overestimate needs, since moderate caloric intake (ie, 33 to 65% of ACCP targets; approximately 9 to 18 kcal/kg per day) was associated with better outcomes than higher levels of caloric intake.

Key Words: calories • clinical outcomes • critical illness • mechanical ventilation • medical ICU • nosocomial sepsis • nutrition




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