PP013-MON EARLY GOAL DIRECTED NUTRITION SUPPORT: DOES IT IMPACT OUTCOME IN CRITICALLY ILL PATIENTS?

Critical Care II Methods: We prospectively studied 313 post-surgical patients treated in the ICU of University Hospital Center of Tirana. Patients were divided into well-nourished (NRS 2002 < 3) and malnourished groups (NRS 2002 3) according to their nutritional status. All patients were followed clinically until discharge from ICU or death. Results: The mean age was 60.5±16.2 years. The prevalence of pre-operative malnutrition was 61.7%. The incidence of complications was 69.4% in the malnourished vs. 19.2% in the well-nourished patients: Odds ratio (OR): 8.63; 95% confidence interval (CI): 5.04 14.7; p < 0.0001. The incidence of infectious complications was 38.3% in the malnourished vs. 17.5% in the well nourished patients, OR = 2.93, 95% CI: 1.68 5.09; p = 0.0001. Mortality in the malnourished patients was 35.8% vs. 20% in the well nourished, OR = 2.32, 95% CI:1.36 3.97; p = 0.001. Ventilator stay and ICU stay were longer in the malnourished patients, respectively: 2.45±4.48 days vs. 1.40±4.08 days and 10.21±9.17 days vs. 6.87±4.82 days. Malnutrition, as analyzed by a multivariate logistic regression model, is an independent risk factor for higher complications (F = 89.45, P < 0.001), higher infectious complications (F = 15.87, P < 0.001), higher mortality (F = 10.12, P = 0.002), longer ventilator stay (F = 4.59, P = 0.03) and ICU stay (F = 13.62, P < 0.001). Conclusion: This study shows that malnutrition is a significant problem in surgical patients staying for more than four days in the intensive care unit. Pre-operative malnutrition in surgical critically ill patients is an independent risk factor on increased post-operative morbidity and mortality. Disclosure of Interest: None Declared

PP011-MON EARLY ORAL FEEDING FOLLOWING INTESTINAL ANASTOMOSES IN CHILDREN WITH ONCOLOGY PATHOLOGY IS SAFE D. Dmytriiev1 , N. Kosechenko1 , O. Kalinchuk1 , K. Dmytriieva1 . 1 Anesthesiology and Intensive Care, Vinnitsa National Medical University, Vinnitsa, Ukraine Rationale: Oral feeding following intestinal anastomoses is frequently delayed. In settings with limited utilisation of parenteral nutrition, this policy is problematic. This report evaluates the safety of early oral feeding following intestinal anastomoses in children. Methods: A prospective study including 44 children aged 10year-old who had intestinal anastomoses for oncology surgical indications over a 5-year period. Oral feeding was started within 48 (44.3±5.4) hours following surgery, if there was no contraindication. Results: There were 24 (54.5%) boys and 20 (45.5%) girls aged 2 to 10 years (median, 4 years). The indication for surgery was intestinal obstaction in patient with lymphoma abdominal cavity (44, 100%). Type anastomoses were 32 (72.7) ileoileal and 12 (27.3%) ileocolic. Oral feeding was commenced in 40 (90.1%) of the patients within 48 hours, 4 (9.9%) by third day post-operative. Feed-related complication occurred in 6 (13.6%) children, 2 (4.5%) of which was in patients fed within 72 hours post-operative and 1 (2.3%) in those fed after 72 hours. Full oral feed was achieved by fifth

S127 and seventh day post-operative in 3 (6.8%) and 41 (93.2%), respectively. Two (4.5%) patients had oral feeding stopped and recommenced at seventh day post-operative due to feedrelated complications. Conclusion: Early oral feeding following intestinal anastomoses in children with oncology pathology is safe, particularly in the setting of limited availability of parenteral nutrition. Disclosure of Interest: None Declared

PP012-MON INFLUENCE OF INFUSION OF ALBUMIN SOLUTIONS ON THE PREDICTIVE VALUE OF PLASMA ALBUMIN LEVELS IN CRITICALLY ILL PATIENTS D.R. Jackson1 , H. Njimi1 , D. Orbegozo1 , J.-C. Preiser1 . 1 ICU, Erasme University Hospital, Bruxelles, Belgium Rationale: The assessment of nutritional status in critically ill patients can be performed using plasma albumin level (ALB). However, the interpretation of ALB can be confounded by different factors, including the infusion of albumin solutions. Methods: We compared the predictive value of ALB on the mortality rate in the intensive care unit (ICU) before and after legal restriction of the use of albumin solutions, implemented since July 1st , 2012. Demographic data from 222 consecutive patients admitted in the medico-surgical ICU of the Erasme university hospital in Brussels (118 admissions before (group PRE) and 104 admissions after July 1st ) admission and mean ALB values were collected. The proportion of patients treated with an albumin solution was recorded. The predictive value of mean ALB was compared between the two periods using analysis of variance, chi-square and area under the ROC curve (SPSS). Results: The two groups were similar for age (56±18 vs 61±17 years), gender [percentage of males (59 vs 56%)], severity (APACHE II 21±7 vs 22±8) and BMI (22.3[20.0 26.9] vs 24.6 [20.9 30.4]). A significantly higher proportion of patients were treated with albumin in the group PRE (14.4%) than in the group POST (2.9%, p < 0.01). The mean ALB value was stable over the first 3 days in the PRE group (from 3.0±0.8 to 3.0±1.8 g/dl) but decreased in the POST group (from 3.1±0.9 to 2.7±0.8 g/dl). The predictive value of ALB for ICU mortality was lower in the group PRE [0.52 (95% confidence interval (CI) 0.38 0.66)] than in the group POST (0.60 95% CI 0.47 0.73). Conclusion: The predictive value for mortality in the ICU of ALB is low, and the infusion of albumin further decreases this value. The amount of albumin infused in critically ill patients should be taken into account when incorporating ALB into severity scores or nutritional assessment. Disclosure of Interest: None Declared

PP013-MON EARLY GOAL DIRECTED NUTRITION SUPPORT: DOES IT IMPACT OUTCOME IN CRITICALLY ILL PATIENTS? B. Shankar1 , D. Daphnee1 , P. Dhanalakshmi2 , N. Ramakrishnan2 . 1 Department of Dietetics, 2 Department of Critical Care, Apollo Hospitals, Chennai, India Rationale: Early Nutritional Support has been recognized as an essential part of ICU management although definitions of early initiation have been variable [1]. Observational studies have shown that a cumulative calorie debt is associated

S128 with adverse clinical outcomes. We hypothesized that a goal directed early enteral nutrition (EN) support targeting calories and proteins would help improve outcome. Methods: Design: Retrospective observational study. Setting: 24 bedded multi disciplinary adult ICU in a tertiary care hospital in Chennai, India. Period: January to December 2012. Patients: 308 patients in whom EN was initiated and stayed in ICU for at least 3 days. Measurement: Impact of starting early EN and target achievement of energy (20 25 kcal/kg/day) and protein (1 1.5 g/kg/day) needs on Day 1, 3, 5 and Day 7 were correlated with the outcomes in terms of likelihood of hospital discharge. Data were analyzed using SPSS, version 10 and p values were obtained using chi-square test with continuity correction. Results: 308 patients who met eligibility criteria were analyzed. 68.2% patients were having APACHE Score of 25 and 41.9% were moderately malnourished and EN was initiated within 4 hours in 40.3%. Early EN initiation was associated with higher chance of achieving target calories (66.9%, p = 0.02) and protein (64.9%, p = 0.03) by Day 3 which translated to higher likelihood of hospital discharge (66.5%, p = 0.04). Conclusion: Early initiation and goal directed EN targeting both protein and calories and achieving approximately 2/3rd of target within three days is associated with increased likelihood of hospital discharge. We recommend that focused nutrition support teams in ICU should make every attempt to initiate EN within 6 hours and monitor calorie and protein debt on a daily basis and work towards the goal to improve outcomes. References [1] Kreymann KG et al. “ESPEN Guidelines on Enteral Nutrition:Intensive care”. ClinNut(2006) 25, 210 223. Disclosure of Interest: None Declared

PP014-MON NUTRITIONAL GOALS IN CRITICALLY ILL PATIENTS AND HOSPITAL LENGTH OF STAY M. Castro1 , C. Antunes1 , K. Kawamura1 , L.M. Horie2 , F.S. de Souza3 , C.E. Pompilio2 . 1 Clinical Nutrition, Pronto Socorro Central, S˜ ao Bernardo do Campo, 2 Gastroenterology, Faculdade de Medicina da USP, S˜ a Paulo, 3 Clinical Nutrition, Faculdade de Medicina do ABC, Santo Andre, Brazil Rationale: Several studies suggested that energetic and protein deficit impacts clinical outcomes, especially in intensive care unit (ICU). On the other hand, there is evidence to support permissive underfeeding. The aim of our study was to determine whether the dose of energy and protein intake influence the hospital length of stay (H-LOS). Methods: Our study evaluated 128 newly admitted patients in a medical ICU. Energy requirement was estimated by 25 kcal/kg and protein requirement by 1.5 g/kg given exclusively through enteral nutrition. The main data evaluated was average energy and protein intake/target (% goal) during ICU stay. The primary outcomes were H-LOS. The data were statistically analyzed by Mann Whitney test. It was performed a multivariable analysis by stepwise forward to investigate factors that impact in mortality. Results: The mean age of patients were 62.9 (±17.1) and H-LOS in median was 12 (5 30). Patients who stayed more than 12 days in hospital received, in median, 76% of energetic

Poster presentations goal (EG) and 83% of protein goal (PG). And patients who stay less than 12 days received, in median, 67% of EG and 79% of PG (p = 0.014). The EG and PG did not impact in mortality. Conclusion: The permissive underfeeding was associated with shorter H-LOS. Disclosure of Interest: None Declared

PP015-MON NUTRITIONAL STATUS OF PATIENTS UNDERGOING BONE MARROW TRANSPLANTATION A.Z. Pereira1 , R.M. Feron1 , P.V. Campregher1 , S.M.F. Piovicari2 , M. Tanaka2 , A.P. Barrere2 , A.A.F. Ribeiro1 , L.R. Morelli1 , F. L´ ucio2 , J.B. Silva2 , N. Hamerschlak1 . 1 2 Oncology, Nutrition, HIAE, S˜ ao Paulo, Brazil Introduction: The nutritional status of patients undergoing bone marrow transplantation is a prognostic indicator of this procedure. The protein-energy malnutrition and obesity increase the risk of comorbidities, mortality, length of use of immunosuppressive drugs and the development of GVHD. Methods: We studied250 patients who were undergoing bone marrow transplantation (BMT) in Israelita AlbertEinstein Hospital in S˜ a Paulo in the period 2007 to 2012. We performed the classification of nutritional status of patients through the Body Mass Index (BMI) (kg/m2 ). Results: Wefound 22% of patients with normal BMI, 37% overweight, 26% of malnourished, and 15% obese. The lowest mean BMI was found among the haplo patients undergoing BMT, in women and in patients with thalassemia, SCID, and IPEX. Conclusion: Although thenutritional status of our patients are consistent with those found in scientific literature. The association of malnutrition and obesity with risks of morbidity and mortality is a factor which can suffer interventions. Measures to improve the nutritional status should be taken by a multidisciplinary team and constantly evaluated, aiming at reducing risks and complications and improving theresults of the BMT. Disclosure of Interest: None Declared

PP016-MON THE IMPACT OF TPN PHARMACIST ON ASSURING EFFECTIVE AND SAFE TPN ADMINISTRATION IN THE NICU B.H. Abuyassin1 . 1 Pharmaceutical care, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia Rationale: To identify the role of TPN pharmacist on assuring safe and effective TPN administration Methods: The TPN team in King Faisal Specialist Hospital and Research Center located in Riyadh, Saudi Arabia is only team in the Middle East that consists of pharmacists. Once a patient is referred to the TPN team, one from its members will be fully responsible of assuring safe and effective TPN administration to the patient with daily monitoring and follow up. The TPN team is serving all the patients’ population in the hospital including adults, pediatrics and neonates who are not under the neonatal ICU care. Neotologists usually assess the nutritional status of the patient and prescribe the TPN order. However; the TPN team revises the order from two main perspectives; medical perspective (electrolyte adjustments, hepatic, renal functions, etc.) and pharmaceutical product