Background Studies performed to calculate metabolic rate in stroke patients have conflicting results. The indirect calorimetry is the gold standard in measuring resting energy expenditure. We compared the intensive care unit (ICU) mortality and outcome in stroke patients receiving enteral nutrition based on energy requirement calculated by either indirect calorimetry or standard weight-based formula.

Methods Twenty ischemic stroke patients of older than 40 years requiring greater than 2 days of mechanical ventilation were prospectively enrolled. Demographic data, Glasgow Coma Scale (GCS), Canadian Neurological Scale, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were obtained. Patients were randomized to receive enteral nutrition based on energy requirement calculated either by indirect calorimeter (group REEIC) or by standard weight-based measurements (group REEST). Daily ventilatory parameters, Sequential Organ Failure Assessment (SOFA) score, and blood parameters were noted. The ICU mortality/duration of stay/complication and duration of hospital stay were compared. Patient outcome at discharge was assessed using modified Rankin scale (MRS).

Results Baseline characteristics were comparable. There were no ICU deaths in group REEIC. Patients in group REEIC had significantly (p < 0.01) more resting energy requirement and less maximum negative energy balance than those in group REEST. The SOFA score at days 5, 7, and 9 and the total leukocyte count (TLC) at day 5 were higher in group REEST. The duration of mechanical ventilation, ICU stay/complications, duration of hospital stay, and MRS at discharge were comparable.

Conclusion Ischemic stroke patients receiving indirect calorimetry–guided enteral nutrition had lesser incidence of organ failure but similar ICU stay and mortality and neurological outcome as compared with those receiving standard weight-based enteral nutrition.

Part of this study was presented at the 47th SNACC Annual Meeting, Phoenix, United States.

Article published online:
08 November 2024

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