(389) Effect of Immobilized Lipase (Relizorb) on Enteral Nutrition Administered in the Surgical ICU

Introduction: Malnutrition is widely prevalent in Intensive care units worldwide and is associated with significant morbidity and mortality. About 48-55% of patients admitted to the ICU with no previous pancreatic pathology are noted to have exocrine pancreatic insufficiency (EPI, due to critical illness, leading to inadequate digestion and absorption of essential nutrients. Oral pancreatic enzyme replacements have proven ineffective in patients receiving tube feeds. When connected in line with tube feeds, the immobilized lipase cartridge breaks down triglycerides and PUFAs and enhances absorption. It is anticipated that its use in the SICU would result in better tolerance, fewer interruptions, and improved nutrient delivery.

Methods: We conducted a retrospective cohort study of adult patients administered either Nutrisource or Relizorb in surgical intensive care units at CCF main campus between January 2017 and August 2021. We excluded patients with confirmed infectious etiology for diarrhea, patients with cystic fibrosis, and patients on Relizorb and Nutrisource concurrently. The primary outcome was the ratio of enteral nutrition administered to the total amount prescribed two days after treatment. The effect of Relizorb on the primary outcome was modeled using multiple linear regression, adjusting for baseline enteral nutrition and confounders related to patient demographics and medical history.

Results: The final study population included 139 patients (Nutrisource = 136, Relizorb = 33). The average baseline enteral nutrition administration ratio was 18% in the Nutrisource group and 14% in the Relizorb group, and after treatment, it was 32% (Nutrisource) and 48% (Relizorb). The regression model estimated a mean difference of 8% (95% CI: -8%, 25%, P-value = 0.331) between Relizorb and Nutrisource, adjusting for baseline enteral nutrition administration ratio and other confounders.

Conclusions: Although not statistically significant, utilization of the Immobilized lipase cartridge (Relizorb) in line with tube feeds in adult patients in the surgical ICU clinically improved the ratio of enteral nutrition administered to prescribed in the first two days after initiation of treatment. Future Prospective randomized controlled studies are warranted to evaluate the specific effects of this intervention.