The impact of fluid therapy on nutrient delivery: A prospective evaluation of practice in respiratory intensive care

Background and Aims: Concurrent therapies are not accounted for nutritional intake. This prospective clinical audit in an intensive care unit aimed at assessing the influence of fluid therapy and drugs containing nutrients on total nutrient delivery. Methods: Fourty-four patients, 25M:19F, age 63±12 (17-83)years, Acute Physiological and Chronic Health Evaluation II: 24±9, with length of stay > 72h, were evaluated. Basal energy expenditure was estimated by the Harris-Benedict formula. All nutrients conveyed by oral, enteral, parenteral nutrition, IV solutions and drugs were daily registered and summed at the end of respiratory intensive care unit stay. Results: Mean estimated basal energy expenditure (BEE), 1372±432 kcal/day, was lower than mean caloric intake 2034±432 kcal/day (P < 0.05), > BEE in 54% of patients. When dextrose/propofol were excluded, mean energy intake, 1375±430 kcal/day, was similar to BEE; 93% and 86% of patients had an adequate carbohydrate and lipid intake, respectively. Dextrose determined an excessive carbohydrate delivery, higher than 58% of calories, in 43% of patients, while 84% had an excessive lipid delivery due to propofol. Excessive sodium from normal saline was administered to 91 % of patients, though 43% had overt oedema. Conclusions: Hypernutrition ensued from non-quantified fluid therapy/drugs. Sodium loads may aggravate lung and gut dysfunction. The provision of 'occult' calories and minerals may be quite substantial and should be taken into consideration.