Early supplemental parenteral nutrition for the achievement of nutritional goals in subarachnoid hemorrhage patients: An observational cohort study.
<h4>Purpose</h4>Enteral nutrition (EN) often fails to achieve nutritional goals in neurocritical care patients. We sought to investigate the safety and utility of supplemental parenteral nutrition (PN) in subarachnoid hemorrhage (SAH) patients.<h4>Materials and methods</h4>Da...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0265729 |
| _version_ | 1818250772541865984 |
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| author | Mario Kofler Ronny Beer Stephanie Marinoni Alois J Schiefecker Maxime Gaasch Verena Rass Anna Lindner Bogdan A Lanosi Paul Rhomberg Bettina Pfausler Claudius Thomé John F Stover Erich Schmutzhard Raimund Helbok |
| author_facet | Mario Kofler Ronny Beer Stephanie Marinoni Alois J Schiefecker Maxime Gaasch Verena Rass Anna Lindner Bogdan A Lanosi Paul Rhomberg Bettina Pfausler Claudius Thomé John F Stover Erich Schmutzhard Raimund Helbok |
| author_sort | Mario Kofler |
| collection | DOAJ |
| description | <h4>Purpose</h4>Enteral nutrition (EN) often fails to achieve nutritional goals in neurocritical care patients. We sought to investigate the safety and utility of supplemental parenteral nutrition (PN) in subarachnoid hemorrhage (SAH) patients.<h4>Materials and methods</h4>Data of 70 consecutive patients with non-traumatic SAH admitted to the neurological intensive care unit of a tertiary referral center were prospectively collected and retrospectively analyzed. We targeted the provision of 20-25 kilocalories per kilogram bodyweight per day (kcal/kg/d) by enteral nutrition. Supplemental PN was given when this target could not be reached. Nutritional data were analyzed for up to 14 days of ICU stay. Hospital complications were tested for associations with impaired enteral feeding. The amounts of EN and PN were tested for associations with the level of protein delivery and functional outcome. Repeated measurements within subjects were handled utilizing generalized estimating equations.<h4>Results</h4>Forty (27 women and 13 men) of 70 screened patients were eligible for the analysis. Median age was 61 (IQR 49-71) years, 8 patients (20%) died in the hospital. Thirty-six patients (90%) received PN for a median duration of 8 (IQR 4-12) days. The provision of 20 kcal/kg by EN on at least 1 day of ICU stay was only achieved in 24 patients (60%). Hydrocephalus (p = 0.020), pneumonia (p = 0.037) and sepsis (p = 0.013) were associated with impaired enteral feeding. Neither the amount nor the duration of PN administration was associated with an increased risk of severe complications or poor outcome. Supplemental PN was associated with significantly increased protein delivery (p<0.001). In patients with sepsis or pneumonia, there was an association between higher protein delivery and good functional outcome (p<0.001 and p = 0.031), but not in the overall cohort (p = 0.08).<h4>Conclusions</h4>Enteral feeding was insufficient to achieve nutritional goals in subarachnoid hemorrhage patients. Supplemental PN was safe and associated with increased protein delivery. A higher protein supply was associated with good functional outcome in patients who developed sepsis or pneumonia. |
| first_indexed | 2024-12-12T15:57:42Z |
| format | Article |
| id | doaj.art-f99f13ef8cfc48f2878f8d35ada016f0 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-12T15:57:42Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-f99f13ef8cfc48f2878f8d35ada016f02022-12-22T00:19:27ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01173e026572910.1371/journal.pone.0265729Early supplemental parenteral nutrition for the achievement of nutritional goals in subarachnoid hemorrhage patients: An observational cohort study.Mario KoflerRonny BeerStephanie MarinoniAlois J SchiefeckerMaxime GaaschVerena RassAnna LindnerBogdan A LanosiPaul RhombergBettina PfauslerClaudius ThoméJohn F StoverErich SchmutzhardRaimund Helbok<h4>Purpose</h4>Enteral nutrition (EN) often fails to achieve nutritional goals in neurocritical care patients. We sought to investigate the safety and utility of supplemental parenteral nutrition (PN) in subarachnoid hemorrhage (SAH) patients.<h4>Materials and methods</h4>Data of 70 consecutive patients with non-traumatic SAH admitted to the neurological intensive care unit of a tertiary referral center were prospectively collected and retrospectively analyzed. We targeted the provision of 20-25 kilocalories per kilogram bodyweight per day (kcal/kg/d) by enteral nutrition. Supplemental PN was given when this target could not be reached. Nutritional data were analyzed for up to 14 days of ICU stay. Hospital complications were tested for associations with impaired enteral feeding. The amounts of EN and PN were tested for associations with the level of protein delivery and functional outcome. Repeated measurements within subjects were handled utilizing generalized estimating equations.<h4>Results</h4>Forty (27 women and 13 men) of 70 screened patients were eligible for the analysis. Median age was 61 (IQR 49-71) years, 8 patients (20%) died in the hospital. Thirty-six patients (90%) received PN for a median duration of 8 (IQR 4-12) days. The provision of 20 kcal/kg by EN on at least 1 day of ICU stay was only achieved in 24 patients (60%). Hydrocephalus (p = 0.020), pneumonia (p = 0.037) and sepsis (p = 0.013) were associated with impaired enteral feeding. Neither the amount nor the duration of PN administration was associated with an increased risk of severe complications or poor outcome. Supplemental PN was associated with significantly increased protein delivery (p<0.001). In patients with sepsis or pneumonia, there was an association between higher protein delivery and good functional outcome (p<0.001 and p = 0.031), but not in the overall cohort (p = 0.08).<h4>Conclusions</h4>Enteral feeding was insufficient to achieve nutritional goals in subarachnoid hemorrhage patients. Supplemental PN was safe and associated with increased protein delivery. A higher protein supply was associated with good functional outcome in patients who developed sepsis or pneumonia.https://doi.org/10.1371/journal.pone.0265729 |
| spellingShingle | Mario Kofler Ronny Beer Stephanie Marinoni Alois J Schiefecker Maxime Gaasch Verena Rass Anna Lindner Bogdan A Lanosi Paul Rhomberg Bettina Pfausler Claudius Thomé John F Stover Erich Schmutzhard Raimund Helbok Early supplemental parenteral nutrition for the achievement of nutritional goals in subarachnoid hemorrhage patients: An observational cohort study. PLoS ONE |
| title | Early supplemental parenteral nutrition for the achievement of nutritional goals in subarachnoid hemorrhage patients: An observational cohort study. |
| title_full | Early supplemental parenteral nutrition for the achievement of nutritional goals in subarachnoid hemorrhage patients: An observational cohort study. |
| title_fullStr | Early supplemental parenteral nutrition for the achievement of nutritional goals in subarachnoid hemorrhage patients: An observational cohort study. |
| title_full_unstemmed | Early supplemental parenteral nutrition for the achievement of nutritional goals in subarachnoid hemorrhage patients: An observational cohort study. |
| title_short | Early supplemental parenteral nutrition for the achievement of nutritional goals in subarachnoid hemorrhage patients: An observational cohort study. |
| title_sort | early supplemental parenteral nutrition for the achievement of nutritional goals in subarachnoid hemorrhage patients an observational cohort study |
| url | https://doi.org/10.1371/journal.pone.0265729 |
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