SUN-PP055: Refeeding Syndrome When We Use Parenteral Nutrition in Surgical Critical Patients: A Retrospective Study

Critical Care P < 0.05). There was no statistically significant difference between IJ and CI (1366±207 kcal/day; P = 0.16). Conclusion: The use of IC should be implemented in the routine of the ICU, in order to improve the nutritional assistance. However, the Ireton-Jones equation is suitable for predicting the REE in elderly mechanically ventilated. The Harris Benedict equation underestimates the REE, and should not be used in this population. Disclosure of Interest: None declared

SUN-PP053 MORE IS NOT ALWAYS BETTER. INFLUENCE OF CALORIC AND PROTEIN INTAKE ON MORBIDITY IN MULTIPLE TRAUMA VENTILATED PATIENTS: A SECONDARY ANALYSIS I. Kagan1 , J. Cohen1 , I. Ben David1 , M. Theilla1 , V. Silva1 , M. Grinev1 , P. Singer1 . 1 Institution for Nutrition Research and Department of General Intensive Care, Rabin Medical Center, Petah-Tikva, Israel Rationale: In the TICACOS study [1], higher caloric intake associated with lower hospital mortality but longer ICU stay. We used the data of a larger RPCT [2] administrating enteral formula to patients with severe trauma and analyzed the influence of caloric intake and nutrients on morbidity. Methods: 120 patients were involved in the study [2]. The study protocol was approved by the local institutional review board. Data collection included REE, total amount of calories, complication rates, LOS and LOV and mortality. The statistical analysis used Pearson correlation. Results: EN reached at least 80% of the target in both groups. Significant correlation was found between amount of calories and incidence of new organ failure (R = 0.31, p = 0.01), ALI/ARDS (R = 0.24, p = 0.01), and VAP (R = 0.29, p = 0.01), LOV (R = 0.32, p = 0.01) and ICU stay (R = 0.32, p = 0.01). Correlations were found between protein and incidence of new organ failure (R = 0.28, p = 0.01), ALI/ARDS (R = 0.21, p = 0.02), and VAP (R = 0.97, p = 0.01), LOV (R = 0.33, p = 0.01) and ICU stay (R = 0.34, p = 0.01). No correlation was found between energy intake, protein intake and 28 survival (R = 0.66, p = 0.47 and R = 0.02, p = 0.81) and hospital survival (R = 0.51, p = 0.58 and R = 0.07, p = 0.39) respectively. Conclusion: In this study where patients were fed close to measured energy expenditure, there was an association between the amount of energy and protein intake and the incidence of complications in trauma patients. Survival was not affected. References [1] P. Singer, et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med (2011) 37: 601 609. [2] I. Kagan, et al. Preemptive enteral nutrition enriched with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in severe multiple trauma: a prospective, randomized, double blind study. Intensive Care Med (2015) 41: 460 469. Disclosure of Interest: None declared

S43 SUN-PP054 LONG TERM EFFECTS OF EPA, GLA AND ANTIOXIDANT ADMINISTRATION ON POST TRAUMATIC STRESS DISORDER (PTSD) FOLLOWING MULTIPLE TRAUMA; A PROSPECTIVE RANDOMIZED DOUBLE BLIND STUDY I. Kagan1 , I. Ben David1 , J. Cohen1 , I. Baniel1 , V. Silva1 , M. Grinev1 , P. Singer1 . 1 Institution for Nutrition Research and Department of General Intensive Care, Rabin Medical Center, Petah-Tikva, Israel Rationale: Clinically important symptoms of PTSD occur in 1/5 of ICU survivors. Fish oil has been shown to protect against various forms of cognitive decline, major depression and anxiety syndromes. The aim of this study was to assess the effects of enteral nutrition (EN) enriched in eicosapentanoic acid, gamma linolenic acid and antioxidants vs. control on signs of PTSD in severe multiple trauma (MT) survivors. Methods: MT patients admitted to the ICU for >48 hours and tolerating EN were randomly divided into a control and intervention group. A secondary end-point of a recently published study [1] included psychometric properties of PTSD evaluated by established questionnaires. Data was collected via face-to-face or telephone interview six months after ICU discharge. Statistical analysis used Wilconxon test and NPAR1WAY procedure. Results: Of the 150 patients included, 52 were interviewed; 98 were excluded due to death within 6 months, inability to communicate, refusal to participate, unreachable and organizational reasons. No differences were found between study and control group in the Post Traumatic Check List Scale (mean 47.03 vs 43.08, resp, p = 0.46), Hospital Anxiety (mean 11.46 vs 9.88, resp, p = 0.33) and depression scale (mean 9.11 vs 7.986, resp, p = 0.33), Rivermead Post Concussion symptoms questionnaire for head trauma patients (mean 4.57 vs 4.30, resp, p = 0.80) and Revised Illness Perceptions Questionnaire (mean 31.11 vs 29.26, resp, p = 0.62). Conclusion: This study failed to show a preventive effect of EN enriched with fish oil on signs of PTSD in patients who survived severe multiple trauma. References [1] I. Kagan, et al. Preemptive enteral nutrition enriched with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in severe multiple trauma: a prospective, randomized, double blind study. Intensive Care Med (2015) 41: 460 469. Disclosure of Interest: None declared

SUN-PP055 REFEEDING SYNDROME WHEN WE USE PARENTERAL NUTRITION IN SURGICAL CRITICAL PATIENTS: A RETROSPECTIVE STUDY I.S. Armas1 , E. Lafuente1 , F. Santos1 , on behalf of UCIP CHTS Penafiel Portugal. 1 CHTS Penafiel, Portugal Rationale: Refeeding syndrome (RS) is a severe electrolyte and fluid shift after reinstating the administration of nutrients. Incidence ranged from 30% when phosphorous (P) was provided in the parenteral nutrition (PN), to 100% with PN without P. The main objective was to identify the incidence of RS after 72 hours (h) of PN on surgical critical care patients. Methods: Retrospective descriptive study, including all surgical patients admitted in 2010 2011 with TPN not less

S44 than 72 h. Age, gender, weight, height, BMI, TPN-time, LOS in the ICU, SAPS II and outcome were obtained from “PICIS® ” informatics data base. Analytic data like sodium (Na), potassium (K), P, magnesium (Mg), chloride (Cl), calcium (Ca), glucose, albumin (Alb), urea, creatinine, bilirubin and alkaline phosphatase were obtained on ClinidataNet® platform. All patients had central SmofKabiven® 1600 kcal without electrolytes. We compared the analytic results before and after 72 h of PN. Results: From 370 patients, 39 (10.5%) were included; 71.7% male, mean age of 61.7±12.5 years. Mean weight and height of 73.9±13.4 kg and 165.4±10.7 cm, with BMI of 26.9±4.1 kg/m2 . Admission after scheduled surgery 25.6%, urgent 69.2% and trauma 5.2%. Sepsis in 61.5%. SAPS II was 45.4±17.5. Length of stay was 9.1±5.1 days. Mortality was 10.2%. We found significant negative deviations in P (p < 0.0001), K (p = 0.009) and Cl (p < 0.0001), and significant positive deviations in Mg (p = 0.001), Ca (p < 0.0001) and Alb (p = 0.003). Average time of PN in ICU was 7.1±4.1 days. Conclusion: RS showed a significant incidence, even when prior malnutrition states were not identified. As TPN without electrolytes could be the reason for RS, we started using TPN with electrolytes despite maintaining adjuvant supplementation. References Crook MA, Hally V. The Importance of the Refeeding Syndrome, Nutrition 2001; 17: 632 637. Disclosure of Interest: None declared

SUN-PP056 POLYMERIC OR PEPTIDE: WHAT IS THE BEST FEED FOR ECMO PATIENTS? M. Fiuza Brito1 , I. de Brito-Ashurst1 . 1 Royal Brompton Hospital, London, United Kingdom Rationale: Feeding patients on extracorporeal membrane oxygenation (ECMO) is challenging. An audit in our hospital showed that ECMO patients were receiving circa 60% of their feed prescription by the fifth feeding day. We attempted to improve nutrition adequacy by changing feed type. Methods: A retrospective review of patients admitted for ECMO; (a) in 2013 on a standard polymeric enteral feed (SEF) as per unit’s protocol (b) in 2014 protocol changed to include a peptide enteral feed (PEF). Aperients and prokinetics were used as per policy. Nutritional goals were set by ICU dietitian based on European Guidelines and patient’s condition. Enteral nutrition was recorded for feeding days 3 and 7 and compared to goals. Data from the two groups were compared via Mann Whitney and Chi-square tests and presented as median and interquartile rank (IQR). Results: Data were collected for 38 venovenous ECMO patients; 20 on PEF and 18 on SEF. Baseline characteristics were similar for the two groups. Median (IQR) for age, BMI and SOFA scores were 50 years (41.3 62.3), 28.2 kg/m2 (24.3 31.3) and 17 (15.8 19.3) respectively for patients on SEF and 56.5 years (50 62), 28 kg/m2 (27.4 29) and 19.5 (12 20) for those on PEF. Patients on PEF tolerated 91% (83 100) of goal nutrition on day 7 compared to 79% (5.3 100) for patients on SEF (p = 0.049). Protein intake was also significantly higher for those on PEF on day 3 [96.5% (93 100) compared to 64% (28 85) on SEF, p < 0.001] and day 7 [98% (90 100) compared

Poster presentations to 56% (4 84) on SEF, p < 0.001]. None of the patients on PEF were on metoclopramide by day 7 compared to 8 patients (p < 0.001) on SEF, of which 5 were also on erythromycin. One patient on SEF, despite combination prokinetics, could not absorb feed and was placed on supplemental parenteral nutrition. Conclusion: Overall, enteral feeding was tolerated in both groups. Patients on PEF received near target goal for proteins and calories mostly without prokinetics. Disclosure of Interest: None declared

SUN-PP057 SHOULD WE REDUCE THE AMOUNT OF CALORIES THAT WE RECOMMEND FOR CRITICALLY ILL PATIENTS? M. Santos1 , R.C. Marinho2 , D. Marques3 , A. Marinho2 . 1 Faculdade de Ciencias da Nutri¸ca ˜o e Alimenta¸ca ˜o da Universidade do Porto, 2 Intensive Care Unit, Centro Hospitalar do Porto, Porto, 3 Unidade Local de Saude de Matosinhos, Matosinhos, Portugal Rationale: Until now guidelines have always stated that the energy needs of critically ill patients are around 20 25 kcal/kg/day. This has been the assumption for over two decades without any scientific evidence to support these recommendations. If we think that we changed most of our clinical practices in the last two decades, ventilating and resuscitating the patient better, we must assume calories needed for these patients, have also changed over time. Methods: Retrospective study made in the Intensive Care Unit of Centro Hospitalar do Porto. We evaluated the energy needs by indirect calometry in the first three days of the stay in ICU. The selection of patients was made randomly over a period of 3 years. Results: 73 patients were enrolled, 65.8% were male, the median age 63.01±17.93, median BMI 26.57±5.24, ICU length of stay of 15.63±15.18 days. Energy needs were evaluated by indirect calometry 21.33±6.64 (19.6) kcal/kg/day, while energy goal estimated by Harris-Bennedict equations without stress factors 20.03±2.43 (19.8) kcal/kg/day. Sedated patients needed 20.88±6.23 kcal/kg/day, while patients without sedation needed 21.20±8.02 kcal/kg/day. Patients with vasopressor agents needed 21.74±6.02 kcal/kg/day while hemodynamically stable patients needed 20.89±7.88 kcal/kg/day. Conclusion: We should be aware that overfeeding of critically ill patients must be avoided. When we create a guideline promoting parenteral nutrition in order to improve the amount of calories given to the patient we must be aware that if we recommend such a high dose of calories per day it would be even worse in parenteral nutrition. With this study we observe that these patients during the first day in ICU need less amount of calories even if they are in critical state like septic shock or even if they are not sedated. So in these patients the ideal amount should be reduced to 15 20 kcal/kg/day to avoid harmful practices. Disclosure of Interest: None declared