Implementation of the ESPEN guidelines in intensive care unit patients qualified for parenteral nutrition

Introduction: Treatment of patients in intensive care units (ICUs) is complex. When planning nutritional therapy the fact of stress malnutrition and related metabolic changes have to be considered.

Aim: The aim of the study was to compare the composition of mixtures for parenteral nutrition administered to the patients of ICU with the ESPEN guidelines.

Material and methods: A retrospective analysis of 2124 prescriptions for individual nutrition bags administered to 160 patients of the Anaesthesiology and Intensive Therapy Clinic in Bydgoszcz between July 2009 and February 2010 was performed. The individual prescriptions were modified according to the patients’ clinical condition. The prescriptions were analysed for the 1st (d1), 2nd (d2) and 3rd (d3) or the other days of the patients’ stay in the ICU.

Results: On d1, average energy intake was 20.46 kcal/kg ibw/ day; on d2 – 21.74 kcal/kg ibw/day; on d3 – 24.5 kcal/kg ibw/ day. Mean values provided in the mixtures were as follows: amino acids 1.01 g/kg ibw/day on d1, on d2 – 1.06 kcal/kg ibw/day, on d3 – 1.26 kcal/kg ibw/day, glucose on d1 – 3.11 g/ kg ibw/day, on d2 –3.23 kcal/kg ibw/day, on d3 – 3.55 kcal/ kg ibw/day and lipids on d1 – 0.52 g/kg ibw/day, on d2 – 0.57 g/ kg ibw/day, on d3 – 0.70 g/kg ibw/day. Average volume of the mixture was as follows: on d1 – 1492.65 ml/day, on d2 – 1535.00 ml/day, on d3 – 1648.00 ml/day.

Conclusions: Mean values of components of parenteral nutrition mixtures were consistent with the guidelines of ESPEN. The differences in the supply of each nutritional component can be explained by variable metabolic status of the analysed patients.