Timing of parenteral nutrition in ICU patients: A transatlantic controversy. (December 2021)

• Record Type: Journal Article
• Authors: Veraar, Cecilia; Geilen, Johannes; Fischer, Arabella; Sulz, Isabella; Tarantino, Silvia; Mouhieddine, Mohamed; Mora, Bruno; Schuh, Christian; Singer, Pierre; Hiesmayr, Michael J.
• Is Part Of: Clinical nutrition ESPEN. Volume 46(2021)
• Page Start: 532
• Page End: 538
• Publication Date: 2021-12
• Subjects: Timing of parenteral nutrition -- Preferable route of administration of artificial nutrition -- Energy targets -- NutritionDay -- Guidelines on clinical nutrition; PN Parenteral Nutrition RCT Randomized Controlled Trials -- ESPEN The European Society of Parenteral and Enteral Nutrition ASPEN The American Society for Parenteral and Enteral Nutrition -- ICU intensive care unit ND nutritionDay -- SAPS severity of illness BMI body mass index; Nutritionally induced diseases -- Periodicals; Metabolism -- Disorders -- Periodicals; 616.39005
• DOI: 10.1016/j.clnesp.2021.08.007
• Languages: English
• ISSNs: 2405-4577

Abstract

Summary: Background and aims: European and North American guidelines on Parenteral Nutrition (PN) and large Randomized Controlled Trials give divergent advices on nutritional therapeutic strategies for critically ill patients. We therefore investigated differences in therapeutic strategies of clinicians between European and Non-European Intensive Care Units (ICU) regarding start day of PN, preferred route of administration and prescription of total energy targets over the years. Methods: In this study 16, 032 patients from 1389 different ICUs were included. Data collection was performed in 28 different European and Non-European ICUs from 2007 to 2018 via nutritionDay, a worldwide-standardized one-day multinational cross-sectional audit. Results: In this analysis an abrupt delay in PN start days was observed in 2011 (7.64 days (4.31; 19.97); p = 0.001) and 2012 (6.41 days (3.1; 9.72); p = 0.001), which was significantly reversed within the following years until 2018. In European, compared to Non-European countries PN prescription was increased (27% versus 13%). Patients from North-America received significantly less kcal per day compared to Europe (−4.3 kcal kg −1 (−6.9; −1.6); p = 0.001). Conclusions: Our study provides further evidence on transatlantic discrepancies in nutritional therapy of ICU patients. Regular audits, such as nutritionDay are substantial for self-reflection of clinical daily practice of intensivists. It is time for worldwide consensus in nutritional therapy by developing worldwide guidelines and supporting standardization in nutrition care of critically ill patients.