Low Energy Intake During the First Week in an Emergency Intensive Care Unit Is Associated With Reduced Duration of Mechanical Ventilation in Critically Ill,Underweight Patients

Abstract

Background: Although nutrition support is essential in intensive care units, optimal energy intake remains unclear. Here, we assessed the influence of energy intake on outcomes of critically ill, underweight patients. Methods: A retrospective chart review was conducted in patients with body mass index (BMI) of <20.0 kg/m² in an emergency intensive care unit (EICU). Patients were categorized into 4 groups by initial Sequential Organ Failure Assessment score (I-SOFA) and average daily energy intake during the first week: group M-1, I-SOFA ≤8 and <16 kcal/kg/d; group M-2, I-SOFA ≤8 and ≥16 kcal/kg/d; group S-1, I-SOFA >8 and <16 kcal/kg/d; and group S-2, I-SOFA >8 and ≥16 kcal/kg/d. Results: The study included 51 patients with a median age of 69 years. No significant differences were noted in all-cause mortality and length of stay in the EICU and hospital between groups M-1 and M-2 or groups S-1 and S-2. The mechanical ventilation duration (MVD) was significantly shorter in group M-1 than M-2 (2.7 [1.0–5.7] vs 9.2 [4.2–17.4] days; P = .040) and in group S-1 than S-2 (3.1 [0.7–6.0] vs 8.8 [6.1–23.1] days; P = .006). The number of patients who underwent tracheostomy in hospital was significantly lower in group S-1 than in S-2 (20% vs 32%; P = .002). Multivariable analyses to adjust for confounders revealed that average energy intake during the first week in EICU was a significant factor independently associated with MVD but not with the requirement of tracheostomy. Conclusion: Reduced energy intake during the first week in EICU was associated with a reduced MVD in clinically ill patients with BMI <20.0 kg/m².