| Summary: | 博士 === 輔仁大學 === 食品營養博士學位學程 === 106 === Malnutrition in the elderly increases the risk of infection, length of hospital stay, mechanical ventilation and intensive care requirements. The purposes of this study were to investigate the caloric requirement and clinical outcomes in mechanically ventilated critically ill elderly patients and identify those at high nutritional risk who require high protein formula intervention. Inclusion criteria were: age ≧65 years old, APACHE Π score 15, mechanical ventilation ≧48 hours and on NG tube feeding. Nutritional risk was screened by mNUTRIC and GNRI. Indirect calorimetry and HB equation were used to assess energy requirements. Paients were randomized 1:1 to two tube feeding regimens: general formula and high protein formula (1.5~2.0 gm/kg BW). Nutritional intake from EN, the type and amount of intravenous nutrition within 7 days, tolerance to feeding, MVD, newly diagnosed VAP, ICU and hospital LOS and date of death were recorded. We used SAS version 9.4 for statistical analysis. Statistically significance was set at =0.05. Among 190 critically ill elderly patients; 177 mechanically ventilated critical elderly underwent IC for measurement of resting energy expenditure (MREE). The MREE was 1444±318 kcal/day, HB(ABW) was 1111±177 kcal/day and HB(IBW) was 1102±113 kcal/day. The stress factor (SFA= MREE HB(ABW)) was 1.43±0.26 for the underweight, 1.30±0.27 for the normal weight, 1.20±0.19 for the overweight and 1.20±0.31 for the obese. The SFI (SFI=MREE HB(IBW)) was 1.24±0.24 for the underweight, 1.31±0.26 for the normal weight, 1.36±0.21 for the overweight and 1.52±0.39 for the obese. The 28-day mortality decreased as EN calorie and protein intake increased. In total, 173 (91.1%) elderly patients were at HNR. HNR patients who consumed 80% of prescribed EN calories had a lower ICU mortality (13.5% vs. 25.8%; P=0.04) and hospital mortality (23.4% vs. 40.3%; P=0.02). Those who consumed 80% of prescribed EN protein had a lower hospital mortality only (23.4% vs. 40.3%; P=0.02). Clinical outcomes and biochemical data were not significantly different between those who were on high protein formula and general formula diet. Critically ill elderly who had 2 symptoms of gastrointestinal intolerance had longer MVD (19.6±11.3 days vs. 11.5±8.8 days; P=0.0001) and ICU LOS (20.1±11.1 days vs. 13.3±8.7 days; P=0.0009). Those on continuous feeding had more symptoms of gastrointestinal intolerance (1.2±0.8 symptoms vs. 0.5±0.7 symptoms; P< 0.0001), longer MVD (16.1±10.8 days vs. 11.2±8.7 days; P=0.001) and longer ICU and hospital LOS (17.1±14.8 days vs. 13.0±11.4 days; P=0.003) (29.1±15.4 days vs. 24.6±14.4 days; P=0.04) than those on bolus feeding. IC is the most accurate method for assessing the calorie requirements of mechanically ventilated critically ill elderly patients. When IC is not available, using the predictive HB equation is an alternative choice. Calorie requirement can be predicted by HB(ABW) 1.20~1.43 for critically ill elderly patients according to different BMI groups, or using HB(IBW)1.24~1.52 for patients with edema, ascites or no body weight data. A very high percentage (91.1%) of elderly MICU patients were at HNR. HNR elderly who had increased EN calories intake had a lower ICU and hospital mortality. Increased EN protein intake lowered hospital mortality only. Symptoms of gastrointestinal intolerance would affect the MVD and ICU LOS. Aggressive nutrition intervention reduced symptoms of feeding intolerance and increased enteral nutrition intake; resulting in reduced hospital mortality in mechanically ventilated critical elderly patients.
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