Monitoring and parenteral administration of micronutrients, phosphate and magnesium in critically ill patients: The VITA-TRACE survey.

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.

Informations de copyright

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of interest Dr. Amrein reports grants, personal fees and other from Fresenius Kabi (Austria), personal fees from Vifor Pharma (Austria), personal fees from Shire now part of Takeda (Austria), outside the submitted work. Dr. Bear reports personal fees from Nutricia (United Kingdom), personal fees from Baxter Healthcare (Global, based in USA), personal fees from Fresenius Kabi (Global, based in Germany), personal fees from Cardinal Health (USA), personal fees from AVANOS (USA), outside the submitted work. Dr. lasocki reports grants and personal fees from VIFOR PHARMA (France), personal fees from PFIZER (France), personal fees and non-financial support from MASIMO (France), non-financial support from PHARMACOSMOS (Denmark), outside the submitted work. Dr. Reintam Blaser reports grants from Fresenius Kabi (Germany), personal fees from Fresenius Kabi (Germany), personal fees from Nestlé (Switzerland), outside the submitted work. Rousseau reports non-financial support from Fresenius (Belgium), personal fees and non-financial support from Baxter (Belgium), non-financial support from Nutricia (Belgium), non-financial support from Nestlé (Belgium), outside the submitted work. Dr. van Zanten reports grants, personal fees and non-financial support from Nutricia Danone (Netherlands), grants from Mermaid (Denmark), personal fees and non-financial support from Fresenius Kabi (Belgium and Netherlands), grants and non-financial support from Cardinal Health (USA), personal fees from Nestle (USA), grants and personal fees from Amomed (Netherlands and Austria), grants and personal fees from Lyric (USA), personal fees from Baxter (Belgium), outside the submitted work. Dr. Casaer reports personal fees from Fresenius Kabi, (Belgium) outside the submitted work. MPC holds a postdoctoral research fellowship supported by the Research Foundation Flanders (1832817N). Gunst J holds a postdoctoral research fellowship supported by the Clinical Research and Education Council of the University Hospitals Leuven (Belgium). The other authors reported no competing interests.