MON-P007: Evaluation of Protein Intake with Total Parenteral Nutrition (TPN) in a Clinical Setting

MON-P007: Evaluation of Protein Intake with Total Parenteral Nutrition (TPN) in a Clinical Setting

Critical Care 2 Methods: This cross-sectional observational study included critically ill patients who were fed enterally and mechanically ventilated...

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Critical Care 2 Methods: This cross-sectional observational study included critically ill patients who were fed enterally and mechanically ventilated. Patients were assessed using Malnutrition Universal Screening Tool (MUST), Phase Angel (PA) by Bioelectrical Impedance Analysis (BIA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). Results: 122 patients were examined. The duration of intensive care admission was 6.25 (IQR 4.3–8.7). 78 (63.9%) of patients were acute emergency cases while 39 (32.0%) were chronic medical cases and 5 (4.1%) were other medical diagnosis. Mean of APACHE II score was 17.93 (SD 7.3). Based on this, 89 patients (73.0%) were found with low PA and the other was found normal. While MUST was ranged from 0 (Low risk) to 2 (high risk), 63 patients (51.6%) were at low risk, 27 (22.1%) were at moderate risk, and 32 (26.3%) were at high risk. Correlation revealed low significant correlation between MUST and both PA and APACHE II (R = 0.41 and 0.57; p = 0.035 and 0.006, respectively). However, high correlation was found between PA and APACHE II (r = 0.89, p < 0.001). Conclusion: The reliance on one tool for nutritional assessment would under-diagnose nutritional status in the critically ill. References 1. Feldblum I, German L, Bilenko NAS, Enten R, Greenberg D, et al. Nutritional risk and health care use before and after an acute hospitalization among the elderly. Nutrition. 2009;25:415–20. 2. Heyland DK, Stephens KE, Day AG, McClave SA. The success of enteral nutrition and ICU-acquired infections: A multicenter observational study. Clinical Nutrition. 2011;30(2):148–55. Disclosure of Interest: None declared.

MON-P005 DIABETES SPECIFIC ENTERAL FORMULAS IN ICU M. Castro1 *, L. M. Horie1, K. S. Kawamura2, F. Rascov2, D. Toledo3. 1Gastroenterology, Faculdade de Medicina da USP, Sao Paulo, 2Nutrition, Pronto Socorro Central, Sao Bernardo, 3 Nutrition, Hospital Albert Einstein, Sao Paulo, Brazil Rationale: Although standard enteral nutrition is universally accepted, the use of disease-specific formulas for hyperglycemic patients is still controversial. This study compares three differents high-protein diabetes-specific formulas to verify the improvement of glycemic control and tolerability. Methods: This was a prospective, open-label, randomized study. The patient groups established according to the highprotein formula received were: group A, Glucerna 1.5 (Abbott), B, Diason 1.5 (Nutricia); group C, Novasource GC 1.5 (Nestle). Inclusion criteria were: expected enteral nutrition ≥5 days, baseline glucose >180 mg/dL in the first 48 h. The targeted glucose level was 110–150 mg/dL. Glycemic variability was calculated as the standard deviation, glycemic lability index and coefficient of variation. We collected daily gastrintestinal events (diarrhea and vomiting). Results: A total of 64 patients were consecutively enrolled (A 20, B 24 and C 18). There were no difference in glucose control between the tthree groups (233 ± 58 vs. 224 ± 46 vs 233 ± 58 IU/ day, p > 0.05). Gastrintestinal events were not different between the groups. Conclusion: In these study, the three diabetes-specific formulas had the same effect in glucose control and gastrintestinal events. Disclosure of Interest: None declared.

S181 MON-P006 MINIMALLY INVASIVE TREATMENT OF ABDOMINAL COMPARTMENT SYNDROME DURING ACUTE PANCREATITIS REDUCES INTOLERANCE OF TUBE FEEDING M. Bezmarevic1 *, M. Panisic1, A. Popadic2, D. Mirkovic1. 1Clinic for General Surgery, 2Clinic of Anesthesiology and Intensive Care, Military Medical Academy, Belgrade, Serbia Rationale: Intolerance of tube feeding (TF) is associate with abdominal compartment syndrome (ACS) and in patients with open abdomen (OA). To compare effects of decompressive laparotomy with temporary abdominal closure (OA) and percutaneous puncture with placement of abdominal catheter (PP) in patients with ACS during severe acute pancreatitis (SAP) regarding tolerance of TF. Methods: Prospective study included 15 patients divided into two groups (8-OA and 7-PP group). APACHE 2 score, intraabdominal pressure (IAP) and tolerance of TF were assessed before and after procedures and comparison between two groups were assessed. Results: Before the procedure APACHE 2 score was 19.5 ± 2.7 in OA group and 19.7 ± 3.9 in PP group ( p = 0.9). Before the procedure IAP was 22 ± 1.4 mmHg in OA group and 23 ± 2.2 mmHg in PP group ( p = 0.14). Intolerance of TF was present in all patients in both groups before procedure. After the procedure APACHE 2 score was 15.7 ± 3.1 in OA group and before 17.3 ± 5.7 in PP group ( p = 0.52). After the procedures IAP was 10 ± 2.1 mmHg in OA group and 14 ± 3.2 mmHg in PP group. After the procedure intolerance of TF was present in 6 (75%) patients in OA group and in one (14%) patient in PP group ( p = 0.001). There was significant difference in APACHE 2 score ( p = 0.001) and IAP ( p < 0.001) before and after procedures, but no significant difference in APACHE 2 score ( p = 0.394) and IAP ( p = 0.144) changes between groups. The significant difference was found between number of patients who did not tolerate TF in PP group before and after procedure ( p < 0.001), but no differences between those patients in OA group ( p = 0.19). Conclusion: Intolerance of TF is present in patients with ACS in SAP. Minimally invasive treatment and decompressive laparotomy have an immediate effect on organ function. Minimally invasive treatment of ACS reduce intolerance of TF more than decompressive laparotomy in patients with SAP. Disclosure of Interest: None declared.

MON-P007 EVALUATION OF PROTEIN INTAKE WITH TOTAL PARENTERAL NUTRITION (TPN) IN A CLINICAL SETTING M. A. Van Kralingen1 *, S. Leij - Halfwerk1, J. van der Linde2, M. Mensink2. 1Hogeschool van Arnhem en Nijmegen, Nijmegen, 2 Rijnstate Hospital, Arnhem, Netherlands Rationale: Sufficient protein intake in patients receiving total parenteral nutrition (TPN) is important for recovery and reducing mortality risk. As it is suspected that protein intake in these patients is below their protein requirements the goal of this study was to evaluate protein intake in patients receiving TPN in a clinical setting. Methods: Protein intake (g/kg body weight) and energy intake were retrospectively collected from patient records of all patients receiving TPN in all hospital wards of Rijnstate Hospital in Arnhem, the Netherlands, between July and

S182 December 2016, and compared with their individual protein and energy requirements. For protein requirement, 1.2 g/kg – according to the ESPEN and ASPEN guidelines– and 1.5 g/kg – taking into account disease-related stress factors– were used. Energy requirement was estimated with Harris & Benedict + 30%. In overweight patients requirements were recalculated to BMI 27 kg/m2. Patients with enteral nutritional intake were excluded. Results: A total of 52 patients were enrolled in this study. The mean protein intake was 1.4 g/kg (SD ± 0.2 g/kg) which was significantly higher than 1.2 g/kg (t-test, p < 0.0005), but lower than 1.5 g/kg (t-test, p = 0,018). Three patients (6%) received less than 1.2 g protein/kg (0.8 g/kg to 1.1 g/kg), whereas 16 patients (31%) received more than 1.5 g/kg (1.6 g/kg to 2.5 g/kg). The mean energy intake was 1,930 kcal (SD ± 300 kcal), which is 99% of mean energy requirement (SD ± 11%, 1,973 kcal±301 kcal). Conclusion: Most patients received sufficient protein with TPN per the minimum requirement of 1.2 g protein/kg. However, to reach the requirement of 1.5 g protein/kg in a clinical setting an amino acid supplement may be indicated to avoid caloric overfeeding. References 1. ASPEN Guidelines for Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient 2016. 2. ESPEN Guidelines on Enteral Nutrition: Intensive Care 2006. Disclosure of Interest: None declared.

MON-P008 SUBSTRATE UTILIZATION AND ADMINISTRATION IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY: A PROSPECTIVE MULTICENTER STUDY M. Hellerman1 *, A. Sabatino2, M. Theilla1, I. Kagan1, E. Fiaccadori2, P. Singer1. 1Intensive Care Unit, Rabin Medical Center, Petah Tikva, Israel, 2Intensive Care Unit, Parma Hospital, Parma, Italy Rationale: The objective of our study is to evaluate the adequacy of nutritional support in intensive care unit (ICU) patients with acute kidney injury (AKI). This was achieved by comparing administered amount of carbohydrates and lipids to substrate utilization calculated from indirect calorimetry measurements. Methods: A prospective multi-center study, (Rabin Medical Center ICU, Israel and the Renal ICU Parma Hospital, Italy) included adult ICU patients with AKI (based on KDIGO criteria) receiving enteral and/or parenteral nutrition. Resting energy expenditure (REE) was measured by indirect calorimetry (Deltatrac II, Datex GE), nitrogen excretion was measured using urinary urea nitrogen and changes in plasma BUN. Fat and carbohydrate oxidation were derived from Weir formulas and compared to daily prescribed and administered fat and carbohydrates. Study was approved by the institutional review board. Wilcoxon Signed Ranks Test was used for statistical analysis. Results: Lipid expenditure was derived from 86 measurements yielding a mean REE of 1,755 cal/24 h (Standard deviation (SD) 406) and an N2 excretion of 12.6 g/24 h (SD 7.4). Mean lipid oxidation was 114 ± g/24 h (SD 66.8), while prescribed lipids were 6 ± g/24 h (SD 32; p < 0.001). Carbohydrate expenditure was derived from 75 measurements yielding a mean REE of

Poster 1,703 cal/24 h (SD 405) and N2 excretion of 11.2 g/24 h (SD 6.6). Mean carbohydrate oxidation was 161 ± g/24 h (SD 176), much lower than prescribed carbohydrates 191 ± g/24 h (SD 76; p < 0.001). Amount of carbohydrates and fat administered correlated to prescribed amount (r = 0.825 and 0.887 respectively). Conclusion: Substrate utilization is not in relation with substrate administration in artificially fed critically ill patients suffering from AKI. Standard nutrition, based on commercial formulas, should be challenged with a guided nutritional approach based on substrate utilization. Disclosure of Interest: None declared.

MON-P009 CAN WE USE PREALBUMIN AS A MARKER FOR NUTRITIONAL STATUS IN CRITICALLY ILL SURGICAL PATIENTS? N.-J. Choi1 *, J. H. Jung2. 1Trauma and Surgical Critical Care, 2 Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Rationale: Serum prealbumin (PAB) is used as a nutrition indicator because it reflects the short-term nutritional status with a short half-life. However, PAB is influenced by not only nutrition therapy, but also other several factors. The purpose of this study was to evaluate the correlation between PAB and CRP and compare with correlation between PAB and nutritional intake in critically ill surgical patients. Methods: This retrospective cohort study included the patients (n = 67) who had been admitted to the surgical intensive care unit (SICU) for more than 7 days in 2015 and checked the level of PAB sequentially two more times. Electronic medical records were reviewed the patient characteristics, nutritional status, PAB, CRP and the amount of nutritional intake. Statistical analysis was performed using Pearson’s correlation coefficient, independent t-test methods of SPSS 21.0 program. Results: The PAB measured just after SICU admission demonstrated no relation with nutritional status (adequate (n = 29), 9.8 ± 5.2 mg/dL vs. malnutrition (n = 38) 10.5 ± 6.3 mg/dL, p = 0.607). In addition, PAB sequentially measured (on ICU 14th day) showed no correlation with the amount of caloric intake (≥25 kcal/kg/day (n = 24) 13.4 ± 6.4 mg/dL vs. <25 kcal/ kg/day (n = 43) 11.2 ± 5.5 mg/dL, p = 0.149). The change of PAB showed correlation with not the amount of nutrition intake (r = 0.129, p = 0.296), but the level of CRP (r = −0.508, p = 0.000). Conclusion: In acute phase of critically ill surgical patients, the level of PAB showed a strong correlation with CRP level, rather than the amount of nutritional intake. Therefore, we should be careful to interpret PAB of critically ill surgical patients. Disclosure of Interest: None declared.

MON-P010 ELEMENTAL VERSUS POLYMERIC ENTERAL NUTRITION IN ICU PATIENTS: WHAT IS PREFERRED? N. Kazeminia1 *, M. Sistanizad1. 1Clinical Pharmacy, School of Pharmacy, Tehran, Islamic Republic of Iran Rationale: Selection of enteral nutrition (EN) formula in ICU patients has become an important topic recently due to its impact hospital expenditure as well as patient’s metabolic