• D Dante Yeh, Miroslav P Peev, Sadeq A Quraishi, Polina Osler, Yuchiao Chang, Erin Gillis Rando, Caitlin Albano, Sharon Darak, and George C Velmahos.
• D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. dyeh2@partners.org.
• Am. J. Crit. Care. 2016 Jul 1; 25 (4): 318-26.

BackgroundAdequate nutritional therapy in critically ill patients is integral to optimal outcome.ObjectiveTo evaluate the association between cumulative macronutrient deficit and overall morbidity in surgical intensive care unit patients.MethodsAdult patients receiving enteral nutrition for more than 72 hours were included if they had no previous admission to the surgical intensive care unit, had received no enteral feedings before admission, had no intestinal obstruction or ileus, and survived 72 hours or more after admission. Data on demographics, outcomes, and nutritional intake during the unit stay were collected for up to 14 days until oral intake began, discharge, or death. Outcome variables included lengths of stay in the hospital and intensive care unit, days with no mechanical ventilation, complications, and mortality.ResultsOf 94 participants, 71% were men, mean age was 63 years, and mean score on the Acute Physiology and Chronic Health Evaluation II was 14. Patients with high cumulative calorie deficit (≥ 6000 cal) and high protein deficit (≥ 300 g) had significantly fewer days with no mechanical ventilation (P < .001), longer unit stays (P < .001), longer hospital stays (P = .007), more total complications (P = .007), and more infectious complications (P = .009) than other participants. These associations remained significant in multivariable models after adjustments for age, sex, reason for admission, and propensity score of deficit. In-hospital and 30-day mortality did not differ.ConclusionsCumulative macronutrient deficits have important clinical outcomes in surgical intensive care patients.©2016 American Association of Critical-Care Nurses.

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