PURPOSE: Nutrition is now viewed as a vital part of ICU management and proper administration of nutritional therapy has been shown to impact outcome in critically ill patients. The Society of Critical Care Medicine (SSCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) published new guidelines for nutrition support of critically ill patients in 2009. This study proposes to evaluate the nutritional support patients receive in the ICU at our facility compared to national guidelines.
METHODS: Study participants were identified using an on-going database of critically ill patients treated at OUMC. A retrospective chart review was performed to determine the following: time between onset of mechanical ventilation to initiation of enteral nutrition, enteral nutrition was given based on published guidelines or documented recommendation from a clinical nutritionist, glutamine supplementation, appropriate holding of enteral nutrition for residuals of 500 cc or greater, use of motility agents, and use of omega three fatty acids supplementation for patients with ARDS. The primary outcome was to evaluate OUMC compliance with the ASPEN/SCCM guidelines outlined above.
RESULTS: The study reviewed 51 patient charts with a median APACHE II on admission of 30 (range 13-46). The study showed variable compliance with ASPEN/SCCM guidelines. The median time to start feeding was 27 hours (range 0-114), with 90% patients feed based on recommendation from a clinical nutritionist. Enteral nutrition was held for low residuals in 12 patients (23%). There was poor disease specific nutrition supplementation, as 19% received glutamine supplementation and 11% received anti-inflammatory lipid supplementation.
CONCLUSIONS: The study showed increasing recognition of the importance of nutrition in critically ill patients. However the wide variability among patients, showed areas for improvement in patient management. Given the wide variation, ICU patients may benefit from feeding protocols.
CLINICAL IMPLICATIONS: Continued education for physicians, nutritionist and nursing staff is necessary for improved patient nutrition supplementation.
DISCLOSURE: The following authors have nothing to disclose: Karen Allen, Jijo John, Gary Kinasewitz
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