The effects of nutrition target on renal function, morbidity, mortality in patients connected with mechanical ventilation in adult intensive care unit

Nutritional support has been accepted as the main component of the treatment in the Intensive Care Unit (ICU). The ideal calorie intake in intensive care unit patients is still a controversial issue. This discussion grew violent with the studies claiming that the low calorie intake would be beneficial as well as the general evidence suggesting that it would be harmful in intensive care unit patients. While the prevalence of the ABH in general society is below 1%; in hospitalized patients, this rate is 2-7%; and 5-30% in patients followed in Intensive Care Units (ICU). The purpose of our study is evaluating the effects of Target Feeding (TF), and Under-Feeding (UF) on renal functions of the patients in Intensive Care Units. The patients who were being followed-up in Anesthesiology and Reanimation Intensive Care Unit between 2003 and 2012 were investigated after the approval of Karadeniz Technical University Clinical Studies Ethical Board was received (2013/82). The patients were separated into two groups as; Group TF (Target Feeding) with the ratio of the daily energy to daily energy need being 70-110%; and Group UF (Under Feeding) with the ratio of the daily energy to daily energy need being below 70% (there were 92 patients in Group TF, and 199 patients in Group UF). The demographic characteristics of the patients, the durations in the intensive care units, re-intubation, resting again in the intensive care unit, the mortality on the 28th day, and the intensive care unit mortality were recorded. For the first 14 days, the Creatinine, BUN, Lactate; OAB in hemodynamic follow-ups (average artery pressures), CVP (Central Venous Pressure), and Daily Liquid Balance were recorded every day as the laboratory parameters of the patients. Again, the vasopressor use of the patients was followed for 14 days. In the light of the up-to-date data, the RIFLE and AKIN Classification Scores were recorded for 14 days to evaluate the renal damage. The issue of whether the patients received RRT treatment or not during these 14 days was also determined. There were no differences in terms of demographic data of the patients. No statistically significant differences were found between the two groups in terms of the 28th day mortality and the Intensive Care Unit mortality (p>0,05). The duration of the stay in intensive care unit was found to be statistically less in Group UF than Group TF (p<0.001). There were no differences between the two groups in terms of renal function at first; however, as the duration of the stay in Intensive Care Unit increased, there were significant differences in Creatinine and BUN values. This development was against the UF (Under-Feeding) Group. According our study underfeeding is correlated with high creatinin and BUN lab paremeters and also worse RIFLE and AKIN scores It was determined that the RRT support that was applied to the patients in our clinic for 10 years were consistent with the international guidelines and the RIFLE and AKI Scores. A consistency over 80% was received with these scoring system whose active usage is still under controversy (p<0,001). As a result, it is clear that low-calorie nutrition strategy in Intensive Care Unit patients caused of renal risk. By the way it has to be reviewed.