Throughout the literature, most discussion regarding nutrition in mechanically ventilated patients is focused on type, composition, and caloric/nitrogen content of available feeding liquids. However, evaluating MEK162 novartis adequate, that is, correct and effective, feeding in this population remains challenging. The present study confirms that energetic requirements in critically ill, mechanically ventilated patients differ considerably in accordance to the severity of the underlying pathology. In general, energetic needs were well anticipated by the attending physicians, yet variations were large. 25% of the caloric prescriptions were correct, but a stunning 75% resulted in under- or overfeeding. Effective administration of calories followed the same trend as the prescription.

However, energetic requirements were met in only 24% of the feeding days. The discrepancy between caloric prescription and intake caused underfeeding in nearly half and overfeeding in 27% of the study days. Our findings also highlighted that nutritional prescription was fairly well translated into effective feeding in the majority of patients but that extreme variations in intake/prescription ratio (up to 720% !) could occur. A possible explanation is that oral nutrition orders were executed without being recorded in the patient’s files. Our results, demonstrating (a) > 90% I/P and P/N ratio after 72 hours, are in agreement and even better than those reported recently by Quenot et al. [18]. However, these authors only studied enteral nutrition aiming at a minimal caloric supply of 25kcal/kg/day and did not calculate stress-adjusted energy requirements.

Interestingly, they found that the I/P ratio was significantly influenced by gastric residual volume measurement [18].Thirty years ago, Driver and LeBrun described iatrogenic malnutrition in more than 80% of mechanically ventilated patients [19]. Although nutrition policy in the ICU has considerably improved since, de Jonghe et al. recently reported that energetic needs Entinostat still remained inadequately covered in more than 20% of ICU patients [11]. McClave et al. reported correct estimation of energetic needs in 29%, overestimation in 58%, and underestimation in 12% of cases. Fifty-eight percent of the patients were overfed, and 39% received too much calories. Correct feeding was provided in 25% of nutrition days which corresponds very well with the 24% incidence observed in our study [10]. Kan et al. reported adequate feeding in 37% and overfeeding in 35% critically ill ventilated patients [6], which also matches our results.