L. TUNG1, R. Dumas1, D. N. Holena1, M. J. Seamon1, L. J. Kaplan1, A. B. Newcomb2, C. P. Michetti2, N. D. Martin1 1University Of Pennsylvania,Philadelphia, PA, USA 2Inova Fairfax Hospital,Falls Church, VA, USA
Introduction: Adequate nutritional support during critical illness has been shown to improve outcomes. Timely initiation of any nutrition can be variable by patient population. We hypothesize that all patient types in a trauma-designated ICU would receive a similar onset of nutritional support, and that pressors would not play a role in nutrition.
Methods: The TRIPP database is a 2-day, multicenter prevalence study of all patients present in a trauma-designated intensive care unit (ICU) on 11/2/17 and 4/10/2018. Patients were stratified as either trauma, general surgery, or medical ICU patients. The presence of any nutritional support was evaluated based on the current ICU length of stay (LOS). Differences in nutritional support over the first 7 days were determined by t-test. Differences in either enteral feeds or parenteral nutrition above or below a total pressor equivalence of norepinephrine (NE) of 0.11mcg/kg/min was determined by chi-square.
Results: 1216 patients from 49 trauma-designated ICUs contributed data. 562 (46.2%) patients were traumatically injured, 458 (37.7%) were general surgery, and 196 (16.1%) were medicine patients. On ICU day 1, 45.7%, 51.1%, 45.5% of trauma, general surgery, and medical ICU patients were receiving nutritional support, respectively. By ICU day 7, this increased to 89.3%, 78.9%, and 80.0%, respectively, with a trend toward statistical significance. There was also no significant difference between the number of patients who were receiving nutrition on NE ≥0.11 mcg/kg/min compared to those on NE ≤0.11mcg/kg/min (p=0.5).
Conclusion: After 7 days of critical illness, a significant percentage of Trauma ICU patients were not receiving nutritional support; further, disparities between ICU populations within trauma-designated ICUs also seemed to exist. Vasopressors however, were not associated with decreased nutritional support. Additional research into the etiologies of these findings is warranted.