Finally, fifty patients, 28 males and 22 females, representing a

Finally, fifty patients, 28 males and 22 females, representing a total of 350 nutrition days, were studied. Mean age was 65 (range 34�C84) years. Mean body weight and length were, respectively, 76.9 �� 18.3kg and 169.6 �� 9.7cm. CHIR99021 IC50 Twelve patients were obese. Mean APACHE II score was28 �� 12. Mean resting energy expenditure for all studied patients was 1361 �� 171kcal/d. Thirteen patients were allocated a stress factor 1.1, 18 patients received 1.2, and 19 subjects were assigned a factor 1.3. This resulted in a mean total energy expenditure of 1649 �� 233kcal/d.The mean daily amount of calories prescribed during the 350 study days reached 1536 �� 602kcal. In average, 1424 �� 572kcal/d were actually delivered to the patient. P and I varied with time (Figure 1). During the study period, median P/N ratio was 0.

97 (range 0.0�C1.80), mean I/N ratio 0.91 (range 0.0�C1.84), and mean I/P ratio, or delivery rate, 0.95 (range 0.08�C7.20).Figure 1Evolution in time of caloric need, prescription and intake over the study period.24.6% of the 350 nutritional prescriptions correctly estimated the need. In 40.0% of cases, nutritional needs were insufficiently covered. Overestimation occurred in the remaining 35.4%.Using similar cutoff percentages to evaluate effective feeding, patients were, respectively, correctly, over-, or underfed in 24.3%, 27.4%, and 48.3% of the nutrition days. Underfeeding was more frequent on the first as compared to the next 6 ventilation days (Figure 2). In fact, either no nutritional prescription was found in the medical records or feeding was started without a formal prescription.

Figure 2Feeding status per day.The amount of effectively administered calories varied with time. Caloric prescription resulted in accurate delivery in 56.0% of cases. However, effective feeding was not met in 32.6% of prescriptions, and in 9.14% actual feeding surpassed the prescribed amount by more than 10%.Mean P/N ratio rose from 59.3 on day 1 to 102.7 on day 7, whilst the median I/N ratio increased from 62.6 to 97 during the same period. Thus, both estimation of needs and actually administered feeding improved with time. The delivery rate did not vary significantly during the observation period (Figure 3).Figure 3Evolution in time of median P/N, I/N, and I/P ratio.4. DiscussionNutrition is an indispensable part of overall treatment in critically ill patients. Fundamental goals of nutritional support in the ICU are to meet energy requirements of (hyper)metabolic processes, to prevent nutrient deficiencies and to minimize protein catabolism. Whilst inadequate nutrition, in general, is known to significantly compromise outcome in the critically ill, its unwarranted effects Drug_discovery may be even more pronounced in mechanically ventilated patients.

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