Background and importance The integration of the pharmacist into the intensive care unit (ICU) is very useful to prevent malnutrition and to reduce mortality among these patients, as the pharmacist can advise the prescriber on how to choose the most appropriate parenteral nutrition (PN).
Aim and objectives To describe and analyse pharmaceutical interventions (PIs) carried out for medical prescriptions of PN in patients admitted to the ICU.
Material and methods A prospective study (June–September 2019) was carried out. Variables included demographics, duration of PN, indication for PN, type of PI and degree of acceptance. The data were obtained from medical and pharmaceutical nutrition records.
Results Fifty-four patients were registered (71% men, average age 65 years (range 39–87)). The average duration of PN was 11 days (1–39). A total of 176 interventions were recorded (3.3 PIs/patient): 91.5% during follow-up and 8.5% after finishing PN. Distribution of PIs according to diagnosis were: polyvalent critical patients (48.1%); postoperative complications (29.6%); colorectal surgery (9.2%); upper gastrointestinal tract surgery (5.7%); pancreatitis (3.7%); and liver diseases (3.7%). According to the type of PI: 36.6% were related to a change in the composition of macronutrients, and 61% of these PIs were related to proteins (78%—increase in order to cover the nitrogen requirements), 23.7% were related to lipids (71%—restriction due to triglycerides >400) and 15.3% were related with carbohydrates (100%—decrease in the supply due to high levels of glycaemia); 31.7% were related to a change in the amount of electrolytes (53%—extra supply; 47%—restriction), with phosphorus being the electrolyte which generated the highest number of PIs (45%); 18.6% were related to addition of insulin in the PN; 10.6% were related to a request for a nutritional profile; and 2.5% were related to cycling of PN due to cholestasis. Most of the PIs (88.7%) were accepted by physicians.
Conclusion and relevance The majority of interventions were due to changes in the composition of macronutrients and micronutrients of the PN, adjusting to the constant changes in the needs of critically ill patients. The high number of PIs per patient and the high degree of acceptance by physicians highlight the significant role of the hospital pharmacist in the nutritional control of critically ill patients.
References and/or acknowledgements No conflict of interest.
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