Introduction
Several studies show that nutrition delivery is insufficient, resulting in large energy deficits during the ICU stay [1]: the problem persists despite the diffusion of guidelines. The barriers to guideline implementation are known [2]. This study aimed at measuring the clinical impact of a two-step interdisciplinary quality nutrition program incorporating knowledge of the barriers.
Methods
A prospective interventional study over three periods (A: baseline, B and C: intervention periods) in the mixed ICU of a university teaching hospital. Inclusion: patients requiring >72 hours of ICU. Intervention was a two-step quality program after baseline analysis: first, implementation of feeding guidelines; and second, additional presence of an ICU dietitian. Variables: anthropometry, severity scores, energy delivery and balances (daily, day 7, discharge), feeding route, length of stay, and mortality.
Results
In total, 604 admissions and 6,073 days were analyzed. Patients in period A were less sick (lower SAPS and less rapidly fatal McCabe scores) than those of periods B and C. Energy delivery and balance increased gradually: impact was particularly marked in the cumulated energy balance on day 7 (P < 0.001). The feeding technique changed: use of EN increased from A to B (stable in C); combined and PN increased progressively. Oral intakes were uniformly low (305 kcal/day). Hospital mortality paralleled severity in periods B and C. The hospital stay was shorter in period C (P = 0.048). See Table 1.
Conclusions
A bottom-up protocol improved nutritional support. The ICU dietitian further improved the process (early introduction, feeding route), achieving better early energy balance.
References
Villet S, Chioléro RL, Bollmann MD, et al.: Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 2005, 24: 502-509. 10.1016/j.clnu.2005.03.006
Jones NE, Suurdt J, Ouelette-Kuntz H, Heyland DK: Implementation of the canadian clinical practice guidelines for nutrition support: a multiple case study of barriers and enablers. Nutr Clin Pract 2007, 22: 449-457. 10.1177/0115426507022004449
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Soguel, L., Revelly, J., Longchamp, C. et al. Energy deficit and hospital length of stay can be reduced by quality management of nutrition therapy: the ICU dietitian is essential. Crit Care 15 (Suppl 1), P376 (2011). https://doi.org/10.1186/cc9796
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DOI: https://doi.org/10.1186/cc9796