The Journal of Trauma: Injury, Infection, and Critical Care · 1987 · 474 citations · 0 references
AgricultureNutritionNutritional SciencesClinical NutritionNutritional Support In Critical CareSepsisCritical Care NutritionNutritional SupportProtein RequirementsSepsis ManagementSeptic ShockWeight LossBody Composition MeasurementCritical Care Nutrition TherapyNutrition In Critical IllnessPostoperative Intensive Care ManagementPostoperative Nutrition SupportSepsis NutritionTotal Body Water DeclineTotal Water Content
Intravenous nutrition is routinely given to septic ICU patients to prevent protein loss, yet its effectiveness has not been directly verified by body composition measurements. The authors employed neutron activation analysis and tritiated water dilution to measure total body water, protein, and fat before and after a 10‑day IVN regimen (2,750 kcal and 127 g of amino acids) in eight ventilator‑dependent septic patients. Despite aggressive IVN, the cohort lost 12.5 % of body protein (≈1.5 kg) while gaining 2.2 kg of fat, experienced substantial water loss, and six of eight patients survived, indicating that protein depletion persists in septic ICU patients and calls for alternative nutritional strategies.
It is current clinical practice to give intravenous nutrition (IVN) to critically ill postoperative septic intensive care patients to prevent loss of body protein, although it has not hitherto been possible to confirm this by direct measurement of body composition. Using a neutron activation analysis facility adapted to provide an intensive care environment and tritiated water dilution we directly measured total body water, protein and fat before and after 10 days of IVN (mean daily non-protein energy and amino acid intakes 2,750 kcal and 127 gm) in eight adult intensive care patients. All patients had recovered from the septic shock syndrome but were still ventilator dependent at the start of IVN. Six patients survived to leave hospital. As a group, the patients lost 12.5% of body protein (mean loss 1.5 ± SE 0.3 kg; p = 0.001) despite a gain in fat (mean 2.2 ± 0.8 kg; p = 0.026). There were, in addition, large losses of body water in most patients (mean, 6.8 ± 2.6 kg; p = 0.036). We conclude that substantial losses of body protein occur in critically ill septic patients despite aggressive nutritional support and that further research is urgently required on the fate of infused substrates and the efficacy of alternative nutritional therapies.