Evaluation of energy intake compared to indirect calorimetry requirements in critically ill patients with acute brain injury.

BACKGROUND Nutrition support in critically ill patients with acute brain injury is vitally important due to known hypermetabolism. We aimed to describe caloric and protein intake within the first 72 hours in a broad neurocritical care population, and compare caloric intake to the indirect calorimetry (IC) resting energy expenditure (REE) target. METHODS IC data, daily caloric and protein intake were collected through chart review over the first 7 days of hospital admission. We evaluated the type and amount of tube feed product received, volume of propofol (1.1 kcal/mL) and clevidipine (2 kcal/mL), and amount of supplemental protein received. RESULTS Ninety-one patients were included with the majority presenting with either intracerebral hemorrhage (35.2%) or acute ischemic stroke (26.4%). The median day of admission that IC was completed and enteral nutrition was initiated was day 3 [2 - 5] and day 1 [1 - 2], respectively. The difference in kilocalories (kcals) received compared to IC REE target within the first 72 hours was significantly different (2831 kcal [1663 - 4072] vs 4275 kcal [3450 - 5811]; Z = -6.469, p <0.001). The median kcals received as tube feeds during the first 72 hours was 88% [55% - 99%] and the mean protein received in the first 72 hours was 0.7 ± 0.5 g/kg/day. CONCLUSION In this population, patients had lower energy intake compared to their caloric needs determined by IC during the first 72 hours of admission but attained 7-day goals. Future studies should investigate barriers to improve caloric delivery in this patient population. This article is protected by copyright. All rights reserved.