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Vol. 48. Issue 6.
Pages 317-325 (June 2024)
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Vol. 48. Issue 6.
Pages 317-325 (June 2024)
Original article
Incidence of hypophosphataemia after ICU admission in mechanically ventilated patients and its relationship with risk factors for refeeding syndrome
Incidencia de hipofosfatemia tras el ingreso en UCI de pacientes en ventilación mecánica y su relación con los factores de riesgo del síndrome de realimentación
Manuel Colmeneroa,b,
Corresponding author
macol@telefonica.net

Corresponding author.
, Rocío Morónc,b, Inmaculada de Dios-Chacónd, Purificación Fernández-Moralesa, María Reyes Mañas-Verad, Francisco Manzanod,b
a Servicio de Medicina Intensiva, Hospital Universitario Clínico San Cecilio, Granada, Spain
b Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
c Servicio de Farmacia Hospitalaria, Hospital Universitario Clínico San Cecilio, Granada, Spain
d Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Figures (2)
Tables (4)
Table 1. Categories and risk factors (RF).
Table 2. Baseline characteristisc of the patients.
Table 3. Univarte analysis. Groups based on the development, or not, of hypophosphatemia 96 h after the ICU admission.
Table 4. Multivariate analysis.
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Abstract
Objective

To describe the incidence of hypophosphatemia in patients admitted to the ICU who have required mechanical ventilation. To analyze the presence of risk factors and its relationship with nutritional practice.

Design

Prospective observational study.

Setting

Polyvalent ICUs of 2 University Hospitals.

Patients or participants

Patients on invasive mechanical ventilation ≥72 h with normal level of phosphorus at admission.

Interventions

None.

Main variables of interest

Electrolyte levels (phosphorus, magnesium, potassium) were determined on admission to the ICU and at 96 h. Risk categories on admission, caloric intake, insulin doses and acid-base status during the first 4 days of admission were recorded. Incidence was calculated as the number of patients who developed hypophosphataemia after admission. Univariate analysis was performed for between-group comparison and multivariate analysis of potential risk factors.

Results

89 patients were included. The incidence of hypophosphataemia was 32.6%. In these patients phosphorus decreased from 3.57 ± 1.02 mmol/l to 1.87 ± 0.65 mmol/l (52.3%). The mean kcal/kg/24 h provided in the first 4 days was 17.4 ± 4.1, with no difference between the group that developed hypophosphataemia and the group that did not. Significant risk factors were insulin doses administered and pH and PaCO2 values.

Conclusions

The incidence of hypophosphataemia at 96 h from admission in mechanically ventilated patients is high and unrelated to the risk category and hypocaloric nutritional practice used. Insulin dosis and acid-base status are the main determinants of its occurrence.

Keywords:
Mechanical ventilation
Intensive Care Unit
Hypophosphatemia
Refeeding syndrome
Risk factors
Resumen
Objetivo

Describir la incidencia de hipofosfatemia en pacientes ingresados en UCI que han precisado ventilación mecánica. Analizar la presencia de factores de riesgo y la relación con la práctica nutricional realizada.

Diseño

Estudio observacional prospective.

Ámbito

Ucis polivalentes de 2 Hospitales Universitarios.

Pacientes o participantes

pacientes en ventilación mecánica invasiva ≥72 horas con niveles de fósforo normales al ingreso.

Intervenciones

ninguna.

Variables de interés principales

Se determinaron los niveles de iones (fósforo, magnesio, potasio) al ingreso en UCI y a las 96 horas. Se registraron las categorias de riesgo al ingreso, el aporte calórico, las dosis de insulina y el estado ácido-base durante los primeros 4 días de ingreso. La incidencia se calculó como el número de pacientes que desarrollaron hipofosfatemia tras el ingreso. Se realizó un análisis univariante para la comparación entre grupos y un multivariante de los potenciales factores de riesgo.

Resultados

Se incluyeron 89 pacientes. La incidencia de hipofosfatemia fue del 32.6%. En estos pacientes el fósforo disminuyó de 3,57 ± 1,02 mmol/l a 1,87 ± 0,65 mmol/l (un 52,3%). La media de kCalorías/kg/24 h aportada en los primeros 4 dias fue de 17.4 ± 4.1, no existiendo diferencias entre el grupo que desarrolló hipofosfatemia y el que no. Los factores de riesgo significativos fueron las dosis de insulina administradas y los valores de pH y PaCO2.

Conclusiones

La incidencia de hipofosfatemia a las 96 horas de ingreso en pacientes con ventilación mecánica es elevada y no guarda relación con la categoría de riesgo y la práctica nutricional hipocalórica utilizada. Las dosis de insulina y el estado ácido-base son sus principales determinantes.

Palabras clave:
Ventilación mecánica
Unidad de Cuidados Intensivos
Hipofosfatemia
Síndrome de realimentación
Factores de riesgo

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