A Cross-sectional Study On Nutrition Of Icu Patients In The Mainland China In 2017

Objective To investigate nutritional treatment in intensive care units of the mainland China.Methods A cross-sectional study was conducted in 118 intensive care units(ICU)of 116 mainland hospitals on April 26 th,2017.All patients of these ICUs at 0 o'clock on April 26 th were included.Demographic and clinical parameters of those patients on April 25th(the investigation day)were recorded.It was reviewed the dates of hospitalization,ICU admission and nutrition initiation.The outcome status on 28 days after the investigation day was obtained.Results A total of 1953 patients were collected including 633 females and 1307 males.The mean of age was 64.1±19.29 years old(1950 cases).The means of GCS(Glasgow Coma Scale),SOFA(Sequential Organ Failure Assessment)and APACHE ?(Acute Physiology and Chronic Health Evaluation II)score were 10.76±4.35(1749 cases),5.65±3.52(1783 cases),17.14±7.31(1792 cases).The outcomes of 28 days after the investigation day were 1483 survivors(75.93%),312 non-survivors(15.98%)as 158 cases(8.09%)missing.There were no significant differences between the males and the females in age,severity of disease and outcomes of 28 days while there were significant differences in height and weight.There were 73.7% of patients with normal or mild-injured gastrointestinal function,10.8% with moderate-or severeinjured function,1.7% with gastrointestinal failure.To the investigation day,EN(enteral nutrition)had initiated in 69.4% of patients and PN(parenteral nutrition)had initiated in 36.4% of patients.There were 1720(88.07%)patients with EN administration on the investigation day.The proportion of patients with nausea,vomit/regurgitation,aspiration,abdominal pain,abdominal distention and diarrhea was 4.8%(93),5.4%(105),0.9%(17),8.7%(170),27.5%(538)and 4.3%(84)respectively,while that of patients using EN was 3.1%(40),4.25%(54),0.79%(10),4.41%(56),26.85%(341)and 5.43%(69)correspondingly.The proportion of cases starting EN within 24,48 and 72 hours after ICU entry was 22.4%(437/1953),38.6%(754/1953)and 46.6%(911/1953),respectively.The proportion of cases receiving ?80% estimated energy target(= past body weight ? 25 kcal/kg/day)within 3,7 and 14 days after ICU entry was 12.9%(78/607),18.7%(189/1010)and 23%(305/1325)respectively,while that of cases with EN was 9.9%(60/607),15%(151/1010)and 18.6%(246/1325)correspondingly.By using acute gastrointestinal injury(AGI)? as the reference in a Cox model,patients with AGI?-? were associated with reduced likelihood of EN initiation(HR: 0.46,95% CI: 0.353-0.599;p < 0.001).AGI ? was significantly associated with lower hazard of EN administration(HR: 0.056;95% CI: 0.008-0.398;p = 0.004).In a linear regression model,greater SOFA scores(coefficient:-0.002;95% CI:-0.008 to-0.001;p = 0.024)and male gender(coefficient:-0.144;95% CI:-0.203 to-0.085;p < 0.001)were found to be associated with lower EN proportion.As compared with AGI?,AGI?-? was associated with lower EN proportion(coefficient:-0.206;95% CI:-0.273 to-0.139;p < 0.001).Nutrition implements through mouth and through PN were significantly associated with clinical outcomes in 28 days after the study day by Chi-square test(p = 0.003,0.001).Without correction,oral feeding was a protective factor(OR: 0.641,95% CI: 0.472-0.869)of clinical outcomes in 28 days while PN was a risk factor(OR: 1.365,95% CI: 1.059-1.760).With correction of APACHE ? and(or)SOFA,PN still was a risk factor of clinical outcomes in 28 days.Calories proportion of EN was not significantly associated with clinical outcomes by Chi-square test(p = 0.462),while total calories proportion was significantly associated with clinical outcomes(p = 0.003).In a Logistic regression model on clinical outcome in 28 days after the study day,nutrition treatment,age,AGI grading,maximum blood glucose,SOFA and APACHE?scores were risk factors of death,while blood lymphocyte number was a protective factor.Conclusion Nowadays,most of patients in the mainland ICUs receive nutrition therapy and the EN usage rate is much higher than the PN rate.However,the time of EN initiation and the target-reaching rate of energy are suboptimal and an individualized plan of nutrition therapy is still missing.Details of energy delivery still need to be improved.