The hypothesis that persistent hypocaloric feeding and negative energy balances are associated with poor outcome in the sickest critically ill patients was verified. This study investigated the nutritional support over 669 ICU days in 48 very sick patients with prolonged ICU stay. It confirms the difficulty to keep a positive energy balance using the enteral route. Only 11 patients (23%) were in positive balance at the end of their stay, while 37 were in negative balance throughout. These results were observed in an ICU which has been applying feeding protocols for a prolonged period of time.Infection are a classical complication of malnutrition and underfeeding: a recent study including 138 medical ICU patients, showed that hypocaloric feeding was associated with increasing blood stream infection. Another study including 200 medical ICU patients. Observed a reduction in length of mechanical ventilation associated with improved nutritional support. The negative energy balance was strongly correlated with complications and particularly with the infectious complications. The multiple regression analysis showed that energy balance at the end of the first week, and the cumulated energy balance of ICU stay were the strongest predictors of prolonged ICU stay. Correlation dose still not mean causality. It is obvious for any ICU specialist, that the longer the stay, the likelier a patient is to have experienced complications and to have received antibiotics at some stage: the most severe patients are also the most difficult to feed by the enteral route. The fact that this negative correlation was already present at the end of the role of the negative balances in favoring complications and the initiation time of feeding also supports the hypothesis.
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