Phase-dependent intake and 90-day mortality by nutrition status in invasive mechanical ventilation critically ill adults: A retrospective cohort study.

BACKGROUND AND

objectivesThere has been a debate regarding appropriate nutrition support during the ear-ly stages of intensive care unit (ICU) admission. This study investigated nutrition support implementation and its relationship with clinical outcomes based on nutrition status. METHODS AND STUDY

designWe performed a retrospective cohort study of 595 critically ill adults receiving invasive mechanical ventilation. Patients were assessed by Global Leadership Initiative on Malnutrition criteria. Stages following ICU admission were cate-gorized as early acute phase (days 1-3), late acute phase (days 4-6), and recovery phase (days 7-10). Patients were divided into energy intake categories (<10, 10-20, and >20 kcal/kg/day) and protein intake cate-gories (<0.8, 0.8-1.2, and >1.2 g/kg/day). We examined differences in 90-day mortality at each stage using Cox proportional hazards analyses for total cohort, well-nourished, and malnourished groups.

resultsMortality was not associated with nutrition intakes during the early and late acute phases. However, higher energy intake during the recovery phase was associated with lower mortality in total cohort (p = 0.002). Significant associations between energy intake and mortality during the recovery phase were observed in both well-nourished and malnourished patients (p = 0.007 and p = 0.05, respectively). Additionally, protein intake during the recovery phase was associated with mortality, specifically in malnourished patients (p = 0.007), but not in well-nourished patients.

conclusionsEnergy intake after 7 days in ICU was associated with mortality in both nutrition status groups, while protein intake showed benefit only in malnourished patients. Therefore, phase-dependent nutrition intake depending on nutrition status may be applicable for optimizing ICU nutri-tion support strategies.