ASSESMENT OF NUTRITIONAL PRACTICE IN PEDIATRIC INTENSIVE CARE UNIT OF AIN SHAMS UNIVERSITY-STUDYING THE EFFECT OF ENTERAL VERSUS PARENTERAL NUTRITION ON PATIENTS' OUTCOME

Abstract

SUMMARY N utrition therapy through PICU include three forms enteral nutrition(EN), parenteral nutrition (PN), mixed feeding (EN+PN). Those forms performed to reach energy and caloric goals of critically ill patients admitted in PICU. We had a cohort observational study about six months duration from April 2015 till October 2015. This study was done on fifty patients admitted in PICU of El-Demerdash hospital aged from (one month-18 years old). From our study we have found that enteral nutrition was the best form of nutrition and had a better outcome on patients than other forms of nutrition. Outcome include incidence of sepsis, length of stay in PICU, mechanical ventilation usage duration and mortality. Patients with parenteral nutrition were more susceptible to sepsis than patients with other forms of feeding which had an increase in rate of mortality, and probability of mechanical ventilation usage in PICU as a complication of sepsis. Also onset of nutrition start in PICU affect outcome better more as the early the onset of nutrition start especially in enteral nutrition the better the outcomes (Length of stay in PICU, sepsis, mechanical ventilation usage and mortality). We found that patients with enteral nutrition had reached their 50% of goals of calories and proteins in a short time as compared by patients with parenteral nutrition and patients with mixed feeding. The shorter in duration they reach their goals the better in their outcome (sepsis, length of stay and mortality). Patients admitted in PICU with low anthropometric measures as weight, height, head circumference, mid upper arm circumference had been at high risk of sepsis, mechanical ventilation use, and long duration of mechanical ventilation usage and mortality. We didn't find any statistical significance between anthropometric measures of critically ill patients at time of admission before nutrition and after start of nutrition when they reached 50% of their goals may be due to a short duration between admission and time of they reach their goals. We found high significance between nutritional labs as Urinary urea nitrogen (UUN) and Nitrogen balance before start of nutrition (at admission) and when patients had reached 50% of their goals of calories and proteins. That mean Nutrition therapy improve catabolism and negative balance of those patients. Other nutritional labs like albumin and prealbumin measures had improved by nutrition but not statistically significance may be due to short duration between start of nutrition and time to reach 50% of goals. We found in this study that patients who had been on catabolic state on admission who known by negative nitrogen balance and elevated UUN had been at high risk of Sepsis, mechanical ventilation usage and high mortality rate. We found in this study that vasoactive drugs and insulin usage during hospital stay had an effect on incidence of sepsis, mechanical ventilation use and mortality of critically ill patients. Patients on parenteral nutrition or on mixed feeding use vasoactive drugs and insulin more than patients on enteral nutrition The high Critical illness of patients (PIM2 score) which assessed at their admission had a positive highly significant positive correlation with both PIM2 score assessed at 50 % of goals and PIM2 score assessed at discharge. That mean nutrition status of patients not affect the critical illness of the patient alone. Other factors affect critical illness of patients beside nutrition status like mechanical ventilation use, sepsis. The high the critical illness measure at admission the high in the rate of mortality in patients admitted in PICU.