Nutritional support and metabolic control technologies in intensive care units. Results of a multicenter prospective screening study

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INTRODUCTION: Nutritional support is an integral part of the treatment process in the intensive care unit (ICU). Patients in critical care receive some methods of enteral or parenteral nutrition based on often conflicting guidelines and controversial strategies. OBJECTIVE: To identify key trends in the use of metabolic control and nutritional support technologies in ICUs of different profiles. MATERIALS AND METHODS: The project of this screening study was developed by members of the FAR RF Committee on Nutritional Support and Metabolic Control. The design trial was simple random sampling. The study included 569 ICU patients. Results. The mean age of the patients was 59.22 ± 17.93 years. APACHE II scale — 1.3 ± 3.9 points, according to SOFA scale — 3.7 ± 1.5 points. 56 % of patients underwent surgical interventions, 45 % were on mechanical ventilation, 28-day mortality — 24 %. In 25 % of oncological patients the total protein was below 50 g\l. Serum albumin level was statistically significantly lower (p = 0,013) in the group of patients with acute cerebral insufficiency (ACI) in comparison with oncosurgical patients. In 25 % of multidisciplinary ICU patients albumin concentration was below 25 g/l. Energy requirement was determined empiricaly in 44 % of oncologic patients, in 50 % of patients with ACI the method of c equations was used, and indirect calorimetry was used in all groups in no more than 1 % of cases. Protein requirements were empirically determined in 20 % of cases in all groups. 35 % of physicians estimated the protein requirement based on the value of 1.2–1.5 g/kg/day. Enteral tube feeding was more frequently used by 70 % of ACI patients and 29 % in the oncology group. In contrast, 29 % of oncologic patients received parenteral nutrition. Only 5 % of patients with ACI required parenteral nutrition. CONCLUSIONS: The majority of ICU patients are characterized by such manifestations of protein-energy deficiency as hypoproteinemia, hypoalbuminemia, hypotransferrinemia. Enteral tube feeding is the prevailing method of nutritional support in ICU. The main problem identified in the course of screening should be considered the very rare use of metabolic monitoring technologies and the lack of a personalized approach to the selection of the nutritional support program.

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