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The Association Between Nutritional Adequacy and Long-Term Outcomes in Critically Ill Patients Requiring Prolonged Mechanical Ventilation

A Multicenter Cohort Study*

Wei, Xuejiao MSc1; Day, Andrew G. MSc1,2; Ouellette-Kuntz, Hélène PhD1; Heyland, Daren K. MD, MSc2,3

doi: 10.1097/CCM.0000000000001000
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Objective: To examine the association between short-term nutritional adequacy received while in the ICU and long-term outcomes including 6-month survival and health-related quality of life in critically ill patients requiring prolonged mechanical ventilation.

Design: Retrospective analysis of data prospectively collected in the context of a multicenter randomized controlled trial.

Setting: An international sample of ICUs.

Patients: Adult patients who were mechanically ventilated for more than 8 days in the ICU.

Interventions: None.

Measurements and Main Results: Nutritional adequacy was obtained from the average proportion of prescribed calories received over the amount prescribed during the first 8 days. Survival status and health-related quality of life as assessed using the Short-Form 36 v2 were obtained at 3- and 6 months post ICU admission. Of the 1,223 patients enrolled in the randomized controlled trial, 475 met the inclusion criteria for this study. At 6-month follow-up, 302 of the 475 patients (64%) were alive. Survival time in those who received low nutritional adequacy was significantly shorter than those who received high nutritional adequacy while adjusting for important covariates (adjusted hazard ratio, 1.7; 95% CI, 1.1–2.6). At 3-month follow-up, a 25% increase in nutritional adequacy was associated with improvements in Physical Functioning and Role Physical of 7.3 (p = 0.02) and 8.3 (p = 0.004) points, respectively. At 6-month follow-up, adjusted increases in Physical Functioning and Role Physical scores for every 25% increase in nutrition adequacy became smaller and were no longer statistically significant (adjusted estimate for Physical Functioning = 4.2, p = 0.14; for Role Physical = 3.2, p = 0.25).

Conclusions: Greater amounts of nutritional intake received during the first week in the ICU were associated with longer survival time and faster physical recovery to 3 months but not 6 months post ICU discharge in critically ill patients requiring prolonged mechanical ventilation. Current recommendations to underfeed critically ill patients may cause harm in some long-stay patients.

1Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada.

2Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.

3Department of Medicine, Queen’s University, Kingston, ON, Canada.

*See also p. 1769.

Ms. Wei and Dr. Heyland conceived the study and drafted the article. Ms. Wei and Mr. Day performed the statistical analysis. All authors participated in the analysis and interpretation of data and revision of the article. All authors read and approved the final article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Ms. Wei’s institution received grant support from the Canadian Institutes of Health Research. Dr. Ouellette-Kuntz’s institution received grant support from the Canadian Institutes of Health Research. Dr. Heyland has received research grants and speaking honorarium from Nestle Healthcare Institute, Baxter, Abbott Nutritional, and Fresenius Kabi. He consulted for GlaxoSmithKline, Theravance, and Lyric Pharmaceuticals. He and his institution received grant support from Nestle Health Sciences and Fresenius Kabi. His institution received grant support from the Canadian Institutes of Health Research, Abbott Nutrition, and Baxter Healthcare. Mr. Day has disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: dkh2@queensu.ca

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