Evaluation of energy intake compared with 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 because of known hypermetabolism. We aimed to describe energy and protein intake within the first 72 h in a broad neurocritical care population and compare energy intake with the indirect calorimetry (IC) resting energy expenditure (REE) target. Methods IC data, daily energy, 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 on which IC was completed and enteral nutrition was initiated was day 3 (2-5) and day 1 (1-2), respectively. The difference in kilocalories received compared with IC REE target within the first 72 h was significantly different (2831 kcal [1663-4072] vs 4275 kcal [3450-5811]; Z = -6.469; P < .001). The median kilocalories received as tube feeds during the first 72 h was 88% (55%-99%), and the mean protein received in the first 72 h was 0.7 +/- 0.5 g/kg/day. Conclusion In this population, patients had lower energy intake compared with their energy needs determined by IC during the first 72 h of admission but attained 7-day goals. Future studies should investigate barriers to improve energy delivery in this patient population.