Enteral nutrition in Australian and New Zealand intensive care units: a point-prevalence study of prescription practices

Abstract

BACKGROUND: Enteral nutrition (EN) is widely accepted as the preferred method for providing nutrition therapy to critically ill patients. However, optimal energy goals and the best way to achieve those goals are ill defined. OBJECTIVE: To determine the type and energy concentration of commonly prescribed EN formulations and whether energy-dense formulations (> 1 kcal/mL) are used. DESIGN: Prospective, observational, multicentre, single-day, point-prevalence study. PARTICIPANTS AND SETTING: All patients present in 38 Australian and New Zealand intensive care units at 10:00 on 17 November 2010. MAIN OUTCOME MEASURES: Demographic data, admission diagnosis and information on EN administration were collected. RESULTS: 522 patients were enrolled. Mean age was 58.7(SD, 17.3) years, 65% were male and 79% were mechanically ventilated. On study day, 220/522 patients received EN (43%; 95% CI, 39%–48%). ICU admission source, Acute Physiology and Chronic Health Evaluation APACHE) III diagnostic category, APACHE II score and ventilation on study day predicted receipt of EN. Of those receiving EN, 111/220 (51%; 95% CI, 44%–57%) received a 1 kcal/mL formulation and the remainder received an energy-dense formulation — 2 kcal/mL, 39/220 (18%; 95% CI, 13%–23%); and 1.5 kcal/mL, 32/220 (15%; 95% CI, 10%–20%). There were no significant predictors for receipt of energy-dense versus 1 kcal/mL EN. CONCLUSIONS: 1 kcal/mL and energy-dense formulations are administered with about equal frequency in Australian and New Zealand ICUs. This finding supports future research into the evaluation of optimal nutritional delivery amounts using EN formulations with differing energy concentrations.