EPIDEMIOLOGIA CLINICA DELLA NUTRIZIONE ARTIFICIALE (ECNA). RISULTATI DI UNO STUDIO PILOTA MULTICENTRICO

A network for the epidemiological surveillance of artificial nutrition (AN) and its adverse effects was developed and tested in 79 hospitals. AN was defined as calorie intake > 1000 kcal/day including both venous (PN) and enteral (EN) routes. Included in the study were 1657 patients who underwent AN during 5 index days chosen 'a priori' twice monthly. Of these, 951 (57.4%) patients were observed in surgical departments, 473 (28.5%) in intensive care units and 233 (14.1%) in internal medicine departments. For each patient personal and anthropometric data, characteristics and adverse reactions of AN were collected. PN was carried out in 1396 (84.2%) patients (50.3% central TPN, 10.8% peripheral TPN, 23.1% PN + EN). EN alone was performed in 261 (13.8%) patients (85.1% nasogastric tube, 14.9% surgical stomies). The average daily calorie intake was 35 kcal/kg for central TPN (71% CHO, 29% fat), 26 kcal/kg for peripheral TPN and 33 kcal/kg for EN. Calorie intake exceeded BEE by 22% on average. The mean daily nitrogen intake was 0.19 g/kg for central TPN, 0.17 g/kg for peripheral TPN and 0.20 g/kg for EN. Adverse reactions were observed in 10.9% of PN patients (4.8% metabolic complications, 3.8% infections) and in 11.5% of EN patients (6.9% diarrhoea or disordered peristalsis). Adverse reactions were responsible for discontinuation of AN in 2.2% of parenterally supported patients and in 5.7% of enterally fed patients. The AN adverse reaction rate seems to be related to the severity of the clinical condition of patients.