J Hum Nutr Diet. 2021 Apr;34(2):413-419. doi: 10.1111/jhn.12835. Epub 2020 Nov 19.

Observational study evaluating the nutritional impact of changing from 1% to 2% propofol in a cardiothoracic adult critical care unit.

Journal of human nutrition and dietetics : the official journal of the British Dietetic Association

Ella Terblanche, Chris Remmington

PMID: 33211347 DOI: 10.1111/jhn.12835

Abstract

BACKGROUND: Nutritional support in the critically ill aims to avoid under and overfeeding, adjusting to changes in energy expenditure during critical illness. The sedation propofol provides significant fat and energy load. We investigated whether changing from 1% to a 2% propofol, would decrease non-nutritional energy, avoid energy overfeeding and increase the amount of protein delivered.

METHODS: A retrospective observational study was performed. The primary outcome was protein delivery. Secondary outcomes were energy from propofol fat and the total energy delivered from nutrition and propofol.

RESULTS: In total, 100 patients were investigated, with 50 patients in each group. The propofol dose was comparable for each group. The nutrition energy prescribed was significantly less for the 1% compared to 2% group, taking the energy from propofol into consideration. Both groups had similar protein targets, although the amount delivered was significantly higher in the 2% group. Thirty-six percent of individuals receiving 1% exceeded 45% of total energy from fat. The poor delivery of nutrition resulted in inadequate energy and protein, irrespective of propofol dose.

CONCLUSIONS: We investigated the impact of propofol on energy overfeeding and under delivery of protein, and highlighted suboptimal nutritional provision. Work is needed to investigate the harm that high-fat delivery may pose in light of poor nutrition delivery.

© 2020 The British Dietetic Association Ltd.

Keywords: critical illness; enteral nutrition; non-nutritional energy; overfeeding; propofol; underfeeding

References

1. Blaser AR, Starkopt J, Alhazzani W et al. (2017) Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med 43, 380-398. - PubMed
2. McClave SA, Taylor BE, Martindale R et al. (2016) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J Parenter Enteral Nutr 40, 159-211. - PubMed
3. Wernerman J, Christopher KB & Annane D (2019) Metabolic support in the critically ill: a consensus of 19. Crit Care 23, 1-10. - PubMed
4. Singer P, Blaser AR, Berger MM et al. (2019) ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 38, 48-79. - PubMed
5. Charrière M, Ridley E, Hastings J et al. (2017) Propofol sedation substantially increases the caloric and lipid intake in critically ill patients. Nutrition 42, 64-68. - PubMed
6. Hastings J, Ridley EJ, Bianchet O et al. (2018) Does propofol sedation contribute to overall energy provision in mechanically ventilated critically ill adults? a retrospective observational study. J Parenter Enteral Nutr 42, 748-757. - PubMed
7. Taylor SJ, Bowles J & Jewkes C (2005) ropofol use precludes prescription of estimated nitrogen requirements. J Intensive Care Med 20, 111-117. - PubMed
8. Heyland DK, Weijs PJ, Coss-Bu JA et al. (2017) Protein delivery in the intensive care unit: optimal or suboptimal? Nutr Clin Pract 32, 58S-71S. - PubMed
9. Zusman O, Theilla M, Cohen J et al. (2016) Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study. Crit Care 20, 367. - PubMed
10. Weijs PJ, Looijaard WG, Beishuizen A et al. (2014) Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care 18, 701. - PubMed
11. Bousie E, van Blokland D, Lammers HJW et al. (2016) Relevance of non-nutritional calories in mechanically ventilated critically ill patients. Eur J Clin Nutr 70, 1443-1450. - PubMed
12. Chapple LAS, Weinel L, Ridley EJ et al. (2019) Clinical sequelae from overfeeding in enterally fed critically ill adults: where is the evidence? J Parenter Enteral Nutr 44, 980-991. - PubMed
13. Williams TJ & Cervenka MC (2017) The role for ketogenic diets in epilepsy and status epilepticus in adults. Clin Neurophysiol Pract 2, 154-160. - PubMed
14. Francis BA, Fillenworth J, Gorelick P et al. (2019) The feasibility, safety and effectiveness of a ketogenic diet for refractory status epilepticus in adults in the intensive care unit. Neurocrit Care 30, 652-657. - PubMed
15. Wesselink E, Koekkoek WAC, Grefte S et al. (2019) Feeding mitochondria: potential role of nutritional components to improve critical illness convalescence. Clin Nutr 38, 982-995. - PubMed
16. Ridley EJ, Peake SL, Jarvis M et al. (2018) Nutrition therapy in Australia and New Zealand intensive care units: an international comparison study. J Parenter Enteral Nutr 42, 1349-1357. - PubMed
17. Segaran E, Lovejoy TD, Proctor C et al. (2018) Exploring fasting practices for critical care patients-a web-based survey of UK intensive care units. J Intensive Care Soc 19, 88-195. - PubMed
18. Villet S, Chiolero RL, Bollmann MD et al. (2005) Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 24, 502-509. - PubMed
19. Mogensen KM, Horkan CM, Purtle SW et al. (2018) Malnutrition, critical illness survivors, and postdischarge outcomes: a cohort study. J Parenter Enteral Nutr 42, 557-565. - PubMed
20. Segaran E, Barker I & Hartle A (2016) Optimising enteral nutrition in critically ill patients by reducing fasting times. J Intensive Care Soc 17, 38-43. - PubMed
21. Jenkins B, Calder PC & Marino LV (2019) Evaluation of implementation of fasting guidelines for enterally fed critical care patients. Clin Nutr 38, 252-257. - PubMed

Publication Types

• Journal Article