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Evaluation of Nutritional Needs of Intensive Care Unit Patients by Clinical Pharmacists

Year 2024, , 29 - 37, 01.03.2024
https://doi.org/10.52794/hujpharm.1302720

Abstract

Malnutrition in intensive care unit (ICU) patients affects disease progression and prolongs hospital stays. In this study, it was aimed to present the recommendations of clinical pharmacists in terms of nutrition in ICU patients. This study was conducted in the ICU between November 2022 and January 2023. Clinical pharmacists counseled patients on nutrition according to guidelines. Basal energy expenditure was calculated using the Harris-Benedict formula, and the most appropriate nutritional product was selected for the patients. Descriptive analyses were performed with SPSS v27.0. Total number of patients and recommendations were 41 and 71, respectively. Hundred percent of the recommendations were accepted. According to the reasons, the recommendation rates were categorized as feeding started (9.86%), feeding stopped (1.41%), feeding dose increased-reduced (28.17%), protein amount increased-reduced (35.21%), management of nutritional complications (15.49%), and changes in administration (9.86%). Enema (54.54%) for constipation, prokinetic metoclopramide (36.36%), and discontinuation of parenteral nutrition due to hyperglycemia (9.09%) were recommended for the management of nutritional complications. Examples of suggestions and explanations made regarding the nutritional status of the patients were given. In this study, recommendations were made for most ICU patients to eat more calories and protein. Clinical pharmacists can prevent malnutrition with other healthcare professionals.

References

  • 1. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36(1):49-64. https://doi.org/10.1016/j.clnu.2016.09.004.
  • 2. Kaddoura R, Shanks A, Chapman M, O’Connor S, Lange K, Yandell R. Relationship between nutritional status on admission to the intensive care unit and clinical outcomes. Nutr Diet. 2021;78(2):128-34. https://doi.org/10.1111/1747-0080.12637.
  • 3. Lew CCH, Yandell R, Fraser RJL, Chua AP, Chong MFF, Miller M. Association between malnutrition and clinical outcomes in the intensive care unit: A systematic review. JPEN-Parenter Enter. 2017;41(5):744-58. https://doi.org/10.1177/0148607115625638.
  • 4. Sungurtekin H, Sungurtekin U, Oner O, Okke D. Nutrition assessment in critically ill patients. Nutr Clin Pract. 2008;23(6):635-41. https://doi.org/10.1177/0884533608326137.
  • 5. Havens JM, Columbus AB, Seshadri AJ, Olufajo OA, Mogensen KM, Rawn JD, et al. Malnutrition at intensive care unit admission predicts mortality in emergency general surgery patients. JPEN-Parenter Enter. 2018;42(1):156-63. https://doi.org/10.1177/0148607116676592.
  • 6. Osooli F, Abbas S, Farsaei S, Adibi P. Identifying critically ill patients at risk of malnutrition and underfeeding: A prospective study at an academic hospital. Adv Pharm Bull. 2019;9(2):314-20. https://doi.org/10.15171/apb.2019.037.
  • 7. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79. https://doi.org/10.1016/j.clnu.2018.08.037.
  • 8. Bechtold ML, Brown PM, Escuro A, Grenda B, Johnston T, Kozeniecki M, et al. When is enteral nutrition indicated? JPENParenter Enter. 2022;46(7):1470-96. https://doi.org/10.1002/jpen.2364.
  • 9. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN-Parenter Enter. 2016;40(2):159-211. https://doi.org/10.1177/0148607115621863.
  • 10. Sondheimer JM. A critical perspective on trophic feeding. J Pediatr Gastroenterol Nutr. 2004;38(3):237-8. https://doi. org/10.1097/00005176-200403000-00001.
  • 11. Lee ZY, Yap CSL, Hasan MS, Engkasan JP, Barakatun-Nisak MY, Day AG, et al. The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2021;25(1):260. https://doi.org/10.1186/s13054-021-03693-4.
  • 12. Zhou X, Qiu F, Wan D, Sun S, Yao G, Liu Y, Li J. Nutrition support for critically ill patients in China: role of the pharmacist. Asia Pac J Clin Nutr. 2019;28(2):246-51. https://doi.org/10.6133/apjcn.201906_28(2).0006.
  • 13. Barak N, Wall-Alonso E, Sitrin MD. Evaluation of stress factors and body weight adjustments currently used to estimate energy expenditure in hospitalized patients. JPEN-Parenter Enter. 2002;26(4):231-8. https://doi.org/10.1177/0148607102026004231.
  • 14. Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy- Westphal A, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):929-36. https://doi.org/10.1016/j.clnu.2014.04.007.
  • 15. Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemansvan Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care. 2014;18(6):701. https://doi.org/10.1186/s13054-014-0701-z.
  • 16. Koekkoek W, van Setten CHC, Olthof LE, Kars J, van Zanten ARH. Timing of PROTein INtake and clinical outcomes of adult critically ill patients on prolonged mechanical VENTilation: The PROTINVENT retrospective study. Clin Nutr. 2019;38(2):883-90. https://doi.org/10.1016/j.clnu.2018.02.012.
  • 17. Wang CY, Huang CT, Chen CH, Chen MF, Ching SL, Huang YC. Optimal energy delivery, rather than the implementation of a feeding protocol, may benefit clinical outcomes in critically ill patients. Nutrients. 2017;9(5). https://doi.org/10.3390/nu9050527.
  • 18. Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, et al. ESPEN practical guideline: Home enteral nutrition. Clin Nutr. 2022;41(2):468-88. https://doi.org/10.1016/j.clnu.2021.10.018.
  • 19. Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017;43(3):380-98. https://doi.org/10.1007/s00134-016-4665-0.
  • 20. Elke G, van Zanten AR, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016;20(1):117. https://doi.org/10.1186/s13054-016-1298-1.
  • 21. Reignier J, Boisrame-Helms J, Brisard L, Lascarrou JB, Ait Hssain A, Anguel N, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018;391(10116):133-43. https://doi.org/10.1016/S0140-6736(17)32146-3.
  • 22. Doğanay M, Akçay K, Çil T, Dağ B, Demirağ K, Demirkan SK, et al. KEPAN Enteral Beslenme (EB) Rehberi. Clin Sci Nutr. 2023;5(Suppl 1):1-29. https://doi.org/10.5152/ClinSci-Nutr.2023.23061.
  • 23. Hrdy O, Vrbica K, Strazevska E, Suk P, Souckova L, Stepanova R, et al. Comparison of continuous versus intermittent enteral nutrition in critically ill patients (COINN): study protocol for a randomized comparative effectiveness trial. Trials. 2020;21(1):955. https://doi.org/10.1186/s13063-020-04866-2.
  • 24. Kahveci FŞ, Demirkan SK, Doğanay M, Gömceli İ, Gündoğan K, Topeli A, et al. KEPAN Parenteral Nütrisyon (PN) Rehberi. Clin Sci Nutr. 2022;4:36-63. https://doi.org/10.5152/ClinSci-Nutr.2022.220124.
  • 25. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008;336(7659):1495-8. https://doi.org/10.1136/bmj.a301.
  • 26. da Silva JSV, Seres DS, Sabino K, Adams SC, Berdahl GJ, Citty SW, et al. ASPEN consensus recommendations for refeeding syndrome. Nutr Clin Pract. 2020;35(2):178-95. https://doi.org/10.1002/ncp.10474.
  • 27. Doig GS, Simpson F, Heighes PT, Bellomo R, Chesher D, Caterson ID, et al. Restricted versus continued standard caloric intake during the management of refeeding syndrome in critically ill adults: a randomised, parallel-group, multicentre, singleblind controlled trial. Lancet Respir Med. 2015;3(12):943-52. https://doi.org/10.1016/S2213-2600(15)00418-X.
  • 28. Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Schneider S, et al. Introductory to the ESPEN guidelines on enteral nutrition: Terminology, definitions and general topics. Clin Nutr. 2006;25(2):180-6. https://doi.org/10.1016/j.clnu.2006.02.007.
  • 29. Bahat G, Akmansu M, Güngör L, Halil M, Bıçaklı DH, Koç N, et al. Beslenme destek tedavisinde oral nütrisyonel destek ürünleri kullanimi: KEPAN Rehberi. Clin Sci Nutr. 2022;4:S1-35. https://doi.org/10.5152/ClinSciNutr.2022.120122.
  • 30. Anker SD, John M, Pedersen PU, Raguso C, Cicoira M, Dardai E, et al. ESPEN guidelines on enteral nutrition: Cardiology and pulmonology. Clin Nutr. 2006;25(2):311-8. https://doi.org/10.1016/j.clnu.2006.01.017.
  • 31. Fiaccadori E, Sabatino A, Barazzoni R, Carrero JJ, Cupisti A, De Waele E, et al. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr. 2021;40(4):1644-68. https://doi.org/10.1016/j.clnu.2021.01.028.
  • 32. Rudis MI, Brandl KM. Position paper on critical care pharmacy services. Society of Critical Care Medicine and American College of Clinical Pharmacy Task Force on critical care pharmacy services. Crit Care Med. 2000;28(11):3746-50. https://doi.org/10.1097/00003246-200011000-00037.
  • 33. Kucukarslan SN, Corpus K, Mehta N, Mlynarek M, Peters M, Stagner L, Zimmerman C. Evaluation of a dedicated pharmacist staffing model in the medical intensive care unit. Hosp Pharm. 2013;48(11):922-30. https://doi.org/10.1310/hpj4811-922.

Evaluation of Nutritional Needs of Intensive Care Unit Patients by Clinical Pharmacists

Year 2024, , 29 - 37, 01.03.2024
https://doi.org/10.52794/hujpharm.1302720

Abstract

Malnutrition in intensive care unit (ICU) patients affects disease progression and prolongs hospital stays. In this study, it was aimed to present the recommendations of clinical pharmacists in terms of nutrition in ICU patients. This study was conducted in the ICU between November 2022 and January 2023. Clinical pharmacists counseled patients on nutrition according to guidelines. Basal energy expenditure was calculated using the Harris-Benedict formula, and the most appropriate nutritional product was selected for the patients. Descriptive analyses were performed with SPSS v27.0. Total number of patients and recommendations were 41 and 71, respectively. Hundred percent of the recommendations were accepted. According to the reasons, the recommendation rates were categorized as feeding started (9.86%), feeding stopped (1.41%), feeding dose increased-reduced (28.17%), protein amount increased-reduced (35.21%), management of nutritional complications (15.49%), and changes in administration (9.86%). Enema (54.54%) for constipation, prokinetic metoclopramide (36.36%), and discontinuation of parenteral nutrition due to hyperglycemia (9.09%) were recommended for the management of nutritional complications. Examples of suggestions and explanations made regarding the nutritional status of the patients were given. In this study, recommendations were made for most ICU patients to eat more calories and protein. Clinical pharmacists can prevent malnutrition with other healthcare professionals.

References

  • 1. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36(1):49-64. https://doi.org/10.1016/j.clnu.2016.09.004.
  • 2. Kaddoura R, Shanks A, Chapman M, O’Connor S, Lange K, Yandell R. Relationship between nutritional status on admission to the intensive care unit and clinical outcomes. Nutr Diet. 2021;78(2):128-34. https://doi.org/10.1111/1747-0080.12637.
  • 3. Lew CCH, Yandell R, Fraser RJL, Chua AP, Chong MFF, Miller M. Association between malnutrition and clinical outcomes in the intensive care unit: A systematic review. JPEN-Parenter Enter. 2017;41(5):744-58. https://doi.org/10.1177/0148607115625638.
  • 4. Sungurtekin H, Sungurtekin U, Oner O, Okke D. Nutrition assessment in critically ill patients. Nutr Clin Pract. 2008;23(6):635-41. https://doi.org/10.1177/0884533608326137.
  • 5. Havens JM, Columbus AB, Seshadri AJ, Olufajo OA, Mogensen KM, Rawn JD, et al. Malnutrition at intensive care unit admission predicts mortality in emergency general surgery patients. JPEN-Parenter Enter. 2018;42(1):156-63. https://doi.org/10.1177/0148607116676592.
  • 6. Osooli F, Abbas S, Farsaei S, Adibi P. Identifying critically ill patients at risk of malnutrition and underfeeding: A prospective study at an academic hospital. Adv Pharm Bull. 2019;9(2):314-20. https://doi.org/10.15171/apb.2019.037.
  • 7. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79. https://doi.org/10.1016/j.clnu.2018.08.037.
  • 8. Bechtold ML, Brown PM, Escuro A, Grenda B, Johnston T, Kozeniecki M, et al. When is enteral nutrition indicated? JPENParenter Enter. 2022;46(7):1470-96. https://doi.org/10.1002/jpen.2364.
  • 9. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN-Parenter Enter. 2016;40(2):159-211. https://doi.org/10.1177/0148607115621863.
  • 10. Sondheimer JM. A critical perspective on trophic feeding. J Pediatr Gastroenterol Nutr. 2004;38(3):237-8. https://doi. org/10.1097/00005176-200403000-00001.
  • 11. Lee ZY, Yap CSL, Hasan MS, Engkasan JP, Barakatun-Nisak MY, Day AG, et al. The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2021;25(1):260. https://doi.org/10.1186/s13054-021-03693-4.
  • 12. Zhou X, Qiu F, Wan D, Sun S, Yao G, Liu Y, Li J. Nutrition support for critically ill patients in China: role of the pharmacist. Asia Pac J Clin Nutr. 2019;28(2):246-51. https://doi.org/10.6133/apjcn.201906_28(2).0006.
  • 13. Barak N, Wall-Alonso E, Sitrin MD. Evaluation of stress factors and body weight adjustments currently used to estimate energy expenditure in hospitalized patients. JPEN-Parenter Enter. 2002;26(4):231-8. https://doi.org/10.1177/0148607102026004231.
  • 14. Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy- Westphal A, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):929-36. https://doi.org/10.1016/j.clnu.2014.04.007.
  • 15. Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemansvan Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care. 2014;18(6):701. https://doi.org/10.1186/s13054-014-0701-z.
  • 16. Koekkoek W, van Setten CHC, Olthof LE, Kars J, van Zanten ARH. Timing of PROTein INtake and clinical outcomes of adult critically ill patients on prolonged mechanical VENTilation: The PROTINVENT retrospective study. Clin Nutr. 2019;38(2):883-90. https://doi.org/10.1016/j.clnu.2018.02.012.
  • 17. Wang CY, Huang CT, Chen CH, Chen MF, Ching SL, Huang YC. Optimal energy delivery, rather than the implementation of a feeding protocol, may benefit clinical outcomes in critically ill patients. Nutrients. 2017;9(5). https://doi.org/10.3390/nu9050527.
  • 18. Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, et al. ESPEN practical guideline: Home enteral nutrition. Clin Nutr. 2022;41(2):468-88. https://doi.org/10.1016/j.clnu.2021.10.018.
  • 19. Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017;43(3):380-98. https://doi.org/10.1007/s00134-016-4665-0.
  • 20. Elke G, van Zanten AR, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016;20(1):117. https://doi.org/10.1186/s13054-016-1298-1.
  • 21. Reignier J, Boisrame-Helms J, Brisard L, Lascarrou JB, Ait Hssain A, Anguel N, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018;391(10116):133-43. https://doi.org/10.1016/S0140-6736(17)32146-3.
  • 22. Doğanay M, Akçay K, Çil T, Dağ B, Demirağ K, Demirkan SK, et al. KEPAN Enteral Beslenme (EB) Rehberi. Clin Sci Nutr. 2023;5(Suppl 1):1-29. https://doi.org/10.5152/ClinSci-Nutr.2023.23061.
  • 23. Hrdy O, Vrbica K, Strazevska E, Suk P, Souckova L, Stepanova R, et al. Comparison of continuous versus intermittent enteral nutrition in critically ill patients (COINN): study protocol for a randomized comparative effectiveness trial. Trials. 2020;21(1):955. https://doi.org/10.1186/s13063-020-04866-2.
  • 24. Kahveci FŞ, Demirkan SK, Doğanay M, Gömceli İ, Gündoğan K, Topeli A, et al. KEPAN Parenteral Nütrisyon (PN) Rehberi. Clin Sci Nutr. 2022;4:36-63. https://doi.org/10.5152/ClinSci-Nutr.2022.220124.
  • 25. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008;336(7659):1495-8. https://doi.org/10.1136/bmj.a301.
  • 26. da Silva JSV, Seres DS, Sabino K, Adams SC, Berdahl GJ, Citty SW, et al. ASPEN consensus recommendations for refeeding syndrome. Nutr Clin Pract. 2020;35(2):178-95. https://doi.org/10.1002/ncp.10474.
  • 27. Doig GS, Simpson F, Heighes PT, Bellomo R, Chesher D, Caterson ID, et al. Restricted versus continued standard caloric intake during the management of refeeding syndrome in critically ill adults: a randomised, parallel-group, multicentre, singleblind controlled trial. Lancet Respir Med. 2015;3(12):943-52. https://doi.org/10.1016/S2213-2600(15)00418-X.
  • 28. Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Schneider S, et al. Introductory to the ESPEN guidelines on enteral nutrition: Terminology, definitions and general topics. Clin Nutr. 2006;25(2):180-6. https://doi.org/10.1016/j.clnu.2006.02.007.
  • 29. Bahat G, Akmansu M, Güngör L, Halil M, Bıçaklı DH, Koç N, et al. Beslenme destek tedavisinde oral nütrisyonel destek ürünleri kullanimi: KEPAN Rehberi. Clin Sci Nutr. 2022;4:S1-35. https://doi.org/10.5152/ClinSciNutr.2022.120122.
  • 30. Anker SD, John M, Pedersen PU, Raguso C, Cicoira M, Dardai E, et al. ESPEN guidelines on enteral nutrition: Cardiology and pulmonology. Clin Nutr. 2006;25(2):311-8. https://doi.org/10.1016/j.clnu.2006.01.017.
  • 31. Fiaccadori E, Sabatino A, Barazzoni R, Carrero JJ, Cupisti A, De Waele E, et al. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr. 2021;40(4):1644-68. https://doi.org/10.1016/j.clnu.2021.01.028.
  • 32. Rudis MI, Brandl KM. Position paper on critical care pharmacy services. Society of Critical Care Medicine and American College of Clinical Pharmacy Task Force on critical care pharmacy services. Crit Care Med. 2000;28(11):3746-50. https://doi.org/10.1097/00003246-200011000-00037.
  • 33. Kucukarslan SN, Corpus K, Mehta N, Mlynarek M, Peters M, Stagner L, Zimmerman C. Evaluation of a dedicated pharmacist staffing model in the medical intensive care unit. Hosp Pharm. 2013;48(11):922-30. https://doi.org/10.1310/hpj4811-922.
There are 33 citations in total.

Details

Primary Language English
Subjects Pharmacology and Pharmaceutical Sciences
Journal Section Research Articles
Authors

Ahmet Çakır 0000-0002-9843-1604

Hasan Memiş 0000-0001-7158-1795

Zeynep Ülkü Gün 0000-0002-7131-6585

Publication Date March 1, 2024
Acceptance Date December 5, 2023
Published in Issue Year 2024

Cite

Vancouver Çakır A, Memiş H, Gün ZÜ. Evaluation of Nutritional Needs of Intensive Care Unit Patients by Clinical Pharmacists. HUJPHARM. 2024;44(1):29-37.