Abstract: TH-PO835
Use of Parenteral Vitamins and Trace Elements for Critically Ill Patients: A Survey of Practice in the United Kingdom
Session Information
- Health Maintenance, Nutrition, Metabolism
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance‚ Nutrition‚ and Metabolism
- 1400 Health Maintenance‚ Nutrition‚ and Metabolism
Authors
- Cameron, Lynda Katherine, Guy's and St Thomas' NHS Foundation Trust, London, London, United Kingdom
- Lumlertgul, Nuttha, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Ostermann, Marlies, Guy's and St Thomas' NHS Foundation Trust, London, London, United Kingdom
Background
Micronutrient products, including parenteral vitamins and trace elements, are prescribed commonly to critically ill patients in the UK for different reasons. Our aim was to explore clinical practice of prescribing micronutrients in the absence of clear evidence or consensus practice guidelines. We were particularly interested in prescribing practice in patients receiving renal replacement therapy (RRT) for acute kidney injury (AKI).
Methods
A 12-question survey was designed and distributed through professional networks of clinicians (physicians, nurses, pharmacists and dietitians) working in UK intensive care in late 2019 – early 2020.
Results
A total of 217 responses to the survey were received from physicians (58%), nurses (16%), pharmacists (15%) and dietitians (11%).
Table 1 shows the proportion of respondents who stated they would prescribe/recommend micronutrient products for renal indications in the ICU.
The reasons underpinning prescribing decisions for patients receiving RRT were variable: to replace water soluble vitamins lost via the filter circuit (20%), to treat concurrent disease states (8%), to both replace losses and treat an underlying condition (24%), unsure (18%), for another reason (6%) and declined to answer (24%).
Conclusion
These results show heterogeneity in reported prescribing practice. Only 1 in 5 respondents considered AKI in critical illness (whether receiving RRT or not) to be an indication for parenteral micronutrient administration, despite altered micronutrient status being reported in this cohort. A decision to prescribe micronutrients to patients on RRT may be based on the loss of water soluble substances in RRT effluent (which has been demonstrated for some micronutrients), a potential treatment effect of micronutrients, or a combination of both. As the evidence base and cost-benefit ratio in this population is uncertain, further research is needed to better define their place in therapy.
Renal indications for prescribing micronutrients in ICU
| Primary indication | Would prescribe/recommend parenteral vitamins | Would prescribe/recommend parenteral trace elements |
| RRT for any indication | 43 (19.8%) | 27 (12.4%) |
| AKI requiring RRT | 41 (18.9%) | 33 (15.2%) |
| AKI not requiring RRT | 4 (1.8%) | 4 (1.8%) |
| Known ESRD | 7 (3.2%) | 9 (4.1%) |
AKI = acute kidney injury; ESRD = end stage renal disease; RRT = renal replacement therapy