Clinical outcomes of mechanically ventilated patients in the Intensive Care Unit referred to Clinical Nutrition Services
Introduction: Mechanically ventilated patients are at risk of malnutrition due to multiple factors such as profound catabolism, underlying illness and medications given. Nutritional assessment and intervention are vital in the management of critically ill patients in the critical care unit.This study aims to compare the clinical outcomes of mechanically ventilated patient’s in the intensive care unit referred and not referred to clinical nutrition services
Methods: Retrospective cohort study was conducted to compare the clinical outcomes of mechanically ventilated patients in the intensive care unit referred to clinical nutrition specialists based on the length of Intensive care unit stay and hospital stay, number of days on mechanical ventilator, and mortality compare to those patients not referred. Medical records of mechanically ventilated patients admitted in the Intensive Care Unit from June 1, 2014 to May 31, 2015 who’s aged more than 18years old were reviewed excluding those ventilated after cardiac arrest with possible brainstem damage, whose dependent to mechanical ventilation before admission and those terminally ill.
Results: A total of 84 patients were included in the study, of which 29 were referred to clinical nutrition service. Patients were referred to clinical nutrition services at a median of 4th hospital day, ranging from 1st to the 33th hospital days. Majority of the patients were on mechanical ventilation due to pneumonia, 62.1% for those with referral and 74.6% for those without. The length of stay in the ICU is longer for those with referral (median 10 vs 6 days), and duration in mechanical ventilator days (median 9vs7 days). However, there was no difference in duration of weaning outcome. The mortality rate of those with nutritional referral was lower compared to those not referred, at 17.2% versus 38.2%.
Conclusion: Those patients referred to clinical nutrition services have longer intensive care unit stay and duration in the use of mechanical ventilator and but with lower mortality compared to those not referred. Further data on patient’s nutrition management such as calorie and protein provision, and use of immune-nutrition may be examined.