Nutrient delivery in mechanically ventilated surgical patients in the pediatric critical care unit

Purpose: Inadequate nutrient intake is associated with poor outcomes in critically ill children. We examined macronutrient delivery in surgical patients in the pediatric intensive care unit (PICU). Methods: In a prospective international cohort study of mechanically ventilated children (1 month to 18 years), we recorded adequacy of cumulative nutrient delivery in the PICU. Surgical patients enrolled in this study were included in the current analysis. Protein intake <60% of the prescribed goal was deemed inadequate. Results: Five hundred nineteen surgical patients,45% female, median age 2 years (IQR 05,8), BMI z score 0.26, with 9-day median PICU stay and 60-day mortality 5.8% were enrolled. Three hundred forty-one (66%) patients received enteral nutrition (EN), and median time of initiation was PICU day 2. EN delivery was interrupted in 68% of these patients for a median duration of 9 hours. Median enteral protein delivery was <15% of the prescribed goal and was <60% in two-thirds of the cohort. Patients with inadequate enteral protein delivery had longer time to EN initiation (p < 0.001) and longer duration of EN interruptions (p < 0.001) compared to those with adequate delivery. Conclusion: Enteral protein delivery in critically ill pediatric surgical patients is inadequate. Early EN initiation and minimizing interruptions may increase protein delivery and potentially improve outcomes in this population. (C) 2017 Elsevier Inc. All rights reserved.