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Vankrunkelsven W, Gunst J, Amrein K, Bear DE, Berger MM, Christopher KB, Fuhrmann V, Hiesmayr M, Ichai C, Jakob SM, Lasocki S, Montejo JC, Oudemans-van Straeten HM, Preiser JC, Blaser AR, Rousseau AF, Singer P, Starkopf J, van Zanten AR, Weber-Carstens S, Wernerman J, Wilmer A, Casaer MP. Monitoring and parenteral administration of micronutrients, phosphate and magnesium in critically ill patients: The VITA-TRACE survey. Clin Nutr 2020; 40:590-599. [PMID: 32624243 DOI: 10.1016/j.clnu.2020.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Despite the presumed importance of preventing and treating micronutrient and mineral deficiencies, it is still not clear how to optimize measurement and administration in critically ill patients. In order to design future comparative trials aimed at optimizing micronutrient and mineral management, an important first step is to gain insight in the current practice of micronutrient, phosphate and magnesium monitoring and administration. METHODS Within the metabolism-endocrinology-nutrition (MEN) section of the European Society of Intensive Care Medicine (ESICM), the micronutrient working group designed a survey addressing current practice in parenteral micronutrient and mineral administration and monitoring. Invitations were sent by the ESICM research department to all ESICM members and past members. RESULTS Three hundred thirty-four respondents completed the survey, predominantly consisting of physicians (321 [96.1%]) and participants working in Europe (262 [78.4%]). Eighty-one (24.3%) respondents reported to monitor micronutrient deficiencies through clinical signs and/or laboratory abnormalities, and 148 (44.3%) reportedly measure blood micronutrient concentrations on a routine basis. Two hundred ninety-two (87.4%) participants provided specific data on parenteral micronutrient supplementation, of whom 150 (51.4%) reported early administration of combined multivitamin and trace element preparations at least in selected patients. Among specific parenteral micronutrient preparations, thiamine (146 [50.0%]) was reported to be the most frequently administered micronutrient, followed by vitamin B complex (104 [35.6%]) and folic acid (86 [29.5%]). One hundred twenty (35.9%) and 113 (33.8%) participants reported to perform daily measurements of phosphate and magnesium, respectively, whereas 173 (59.2%) and 185 (63.4%) reported to routinely supplement these minerals parenterally. CONCLUSION The survey revealed a wide variation in current practices of micronutrient, phosphate and magnesium measurement and parenteral administration, suggesting a risk of insufficient prevention, diagnosis and treatment of deficiencies. These results provide the context for future comparative studies, and identify areas for knowledge translation and recommendations.
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Affiliation(s)
- Wouter Vankrunkelsven
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium
| | - Jan Gunst
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium
| | - Karin Amrein
- Medical University of Graz, Division of Endocrinology and Diabetology, Department of Internal Medicine, Graz, Austria
| | - Danielle E Bear
- Guy´s and St Thomas' NHS Foundation Trust, Department of Critical Care and Department of Nutrition and Dietetics, London, United Kingdom
| | - Mette M Berger
- University of Lausanne Hospital - CHUV, Service of Intensive Care Medicine & Burns, Lausanne, Switzerland
| | | | - Valentin Fuhrmann
- University Medical Center Hamburg-Eppendorf, Department for Intensive Care Medicine, Hamburg, Germany
| | - Michael Hiesmayr
- Klinische Abteilung für Herz-Thorax-Gefäßchirurgische Anästhesie & Intensivmedizin, Medizinische Universität Wien, Vienna, Austria
| | - Carole Ichai
- University Côte d´Azur, CHU de Nice, Hôpital Pasteur 2, Department of Anesthesiology and Critical Care Medicine, Nice, France
| | - Stephan M Jakob
- Inselspital, Bern University Hospital, University of Bern, Department of Intensive Care Medicine, Bern, Switzerland
| | - Sigismond Lasocki
- Centre hospitalier universitaire d´Angers, Département Anesthésie-Réanimation, Angers, France
| | - Juan C Montejo
- Hospital Universitario 12 de Octubre, Intensive Care Medicine Department, Madrid, Spain
| | | | - Jean-Charles Preiser
- Erasme University Hospital - Université Libre de Bruxelles, Department of Intensive Care, Brussels, Belgium
| | - Annika Reintam Blaser
- Lucerne Cantonal Hospital, Department of Intensive Care Medicine, Lucerne, Switzerland; University of Tartu, Department of Anaesthesiology and Intensive Care, Tartu, Estonia
| | | | - Pierre Singer
- Rabin Medical Center, Tel Aviv University, General Intensive Care Department and Institute for Nutrition Research, Tel Aviv, Israel
| | - Joel Starkopf
- University of Tartu - Tartu University Hospital, Department of Anaesthesiology and Intensive Care, Tartu, Estonia
| | | | - Steffen Weber-Carstens
- Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Berlin, Germany
| | - Jan Wernerman
- Karolinska University Hospital Huddinge - Karolinska Institutet, Intensive Care Medicine, Stockholm, Sweden
| | | | - Michael P Casaer
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
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