Jocelyn Claytor, PharmD
Dr.
New Hanover Regional Medical center, United States
Disclosure information not submitted.
Lucy Stanke, PharmD, BCPS, BCCCP
Dr
New Hanover Regional Medical Center, United States
Disclosure information not submitted.
Title: Reaching Macronutrient Protein Goals in the ICU with Documented Supplementation
Introduction: Nutrition support is vital in critical illness. To combat protein wasting, guidelines recommend initiating enteral nutrition within 48 hours of ICU admission and adequate protein of 1.2-2 g/kg/day. Medications providing additional non-nutrition calories create challenges to reach adequate protein intake with enteral feeding alone. Though studies suggest protein supplementation is appropriate to achieve high protein intake, limited studies address how to improve physical delivery of protein supplementation.
Methods: This was a single-center, retrospective process analysis of adult patients located in the ICU receiving enteral nutrition while mechanically on propofol. Protein goals were assessed, supplemental protein was dispensed from a hospital pharmacy and documented as administered on a MAR. The primary outcome was percent grams of goal protein requirements reached after protein supplementation on day five of enteral nutrition. Secondary outcomes assessed percent grams of goal protein requirements reached on days one through four of enteral nutrition and weight-based protein intake.
Results: In total 150 met inclusion criteria. On day five of enteral nutrition, the pre-intervention group received 57.2% of goal amino acid. In the post intervention group, patients received 87.7% of goal amino acids. The total overall protein received was greater in the post-intervention group (p < 0.0001). Post-intervention patients received higher weight-based protein (1.4 g/kg vs 0.9 g/kg, p=0.0001) on day 5. There were no reported issues administering the supplementation and 80-100% of ordered doses were administered.
Conclusions: Our data demonstrates that the addition of protein supplementation to the MAR significantly increases patient’s protein intake in the ICU. Previous studies do not address protein delivery processes in the ICU; therefore, this study shows the importance of ensuring a visible process to properly quantify the amount of protein patients receive.