Nutrition in the Surgical Intensive Care Unit: The Cost of Starting Low and Ramping Up Rates.
BACKGROUND Calorie/protein deficit in the surgical intensive care unit (SICU) is associated with worse clinical outcomes. It is customary to initiate enteral nutrition (EN) at a low rate and increase to goal (RAMP UP) Increasing evidence suggests that RAMP UP may contribute to iatrogenic malnutrition. We sought to determine what proportion of total SICU calorie/protein deficit is attributable to RAMP UP. MATERIALS AND METHODS This is a retrospective study of a prospectively collected registry of adult patients (N 109) receiving at least 72 hours of EN in the SICU according to the RAMP UP protocol (July 2012 June 2014) Subjects receiving only trophic feeds or with interrupted EN during RAMP UP were excluded. Deficits were defined as the amount of prescribed calories/protein minus the actual amount received. RAMP UP deficit was defined as the deficit between EN initiation and arrival at goal rate. Data included demographics, nutritional prescription/delivery, and outcomes. RESULTS EN was started at a median of 34.0 hours (interquartile range [IQR] 16.5 53.5) after ICU admission, with a mean duration of 8.7 4.3 days. The median total caloric deficit was 2185 kcal (249 4730) with 900 kcal (551 1562) attributable to RAMP UP (41% The protein deficit was 98.5 g (27.5 250.4) with 51.9 g (20.6 83.3) caused by RAMP UP (53% CONCLUSIONS In SICU patients initiating EN, the RAMP UP period accounted for 41% and 53% of the overall caloric and protein deficits, respectively. Starting EN immediately at goal rate may eliminate a significant proportion of macronutrient deficit in the SICU.
Nutrition in clinical practice official publication of the American Society for Parenteral and Enteral Nutrition