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Nutrition support in the critical care setting: current practice in canadian ICUs--opportunities for improvement?

https://arctichealth.org/en/permalink/ahliterature186906
Source
JPEN J Parenter Enteral Nutr. 2003 Jan-Feb;27(1):74-83
Publication Type
Article
Author
Daren K Heyland
Deborah Schroter-Noppe
John W Drover
Minto Jain
Laurie Keefe
Rupinder Dhaliwal
Andrew Day
Author Affiliation
Department of Medicine, Queen's University, Kingston, Ontario, Canada. dkh2@post.queensu.ca
Source
JPEN J Parenter Enteral Nutr. 2003 Jan-Feb;27(1):74-83
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Critical Care - standards
Cross-Sectional Studies
Female
Humans
Intensive Care Units - standards
Male
Middle Aged
Nutritional Support - standards
Odds Ratio
Time Factors
Abstract
The purpose of this project was to describe current nutrition support practice in the critical care setting and to identify interventions to target for quality improvement initiatives.
We conducted a cross-sectional national survey of dietitians working in intensive care units (ICUs) across Canada to document various aspects of nutrition support practice.
Of the 79 dietitians sent study materials, 66 responded (83%). Sixteen of 66 sites (24.2%) reported the presence of a nutrition support team, and 35 of 66 (53%) used a standard enteral feeding protocol. Dietitians retrospectively abstracted data from charts of all patients in the ICU on April 18, 2001. Of 702 patients, 313 (44.6%) received enteral nutrition only, 50 (7.1%) received parenteral nutrition only, 60 (8.5%) received both, and 279 (39.7%) received no form of nutrition support. Enteral nutrition was initiated on 1.6 days (median) after admission to ICU; 10.7% of patients were initiated on day 1. Of those receiving any form of nutrition support, on average, patients received 58% of their prescribed amounts of calories and protein over the first 12 days in the ICU. Of all days on enteral feeds, patients received feeds into the small bowel on 381 of 2321 (16.4%) days. The mean head of the bed elevation for all patients was 30 degrees. Controlling for differences in patient characteristics, site factors contributing the most successful application of nutrition support included the amount of funded dietitians per ICU bed, size of ICU, and the fact that the ICU was located in an academic setting.
A significant number of critically ill patients did not receive any form of nutrition support for the study period. Those that did receive nutrition support did not meet their prescribed energy or protein needs, especially earlier in the course of their illness. Significant opportunities to improve provision of nutrition support to critically ill patients exist.
PubMed ID
12549603 View in PubMed
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Validation of the Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients: results of a prospective observational study.

https://arctichealth.org/en/permalink/ahliterature176681
Source
Crit Care Med. 2004 Nov;32(11):2260-6
Publication Type
Article
Date
Nov-2004
Author
Daren K Heyland
Rupinder Dhaliwal
Andrew Day
Minto Jain
John Drover
Author Affiliation
Department of Medicine, Queen's University, Kingston, Ontario.
Source
Crit Care Med. 2004 Nov;32(11):2260-6
Date
Nov-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Clinical Protocols - standards
Critical Care - methods - standards - statistics & numerical data
Critical Illness - therapy
Diffusion of Innovation
Enteral Nutrition - standards - statistics & numerical data
Evidence-Based Medicine - standards
Female
Guideline Adherence - statistics & numerical data
Health Services Research
Humans
Information Dissemination
Male
Middle Aged
Needs Assessment
Nutritional Support - methods - standards - statistics & numerical data
Patient Selection
Physician's Practice Patterns - standards - statistics & numerical data
Practice Guidelines as Topic - standards
Prospective Studies
Respiration, Artificial
Abstract
Recently, evidence-based clinical practice guidelines for the provision of nutrition support in the critical care setting have been developed. To validate these guidelines, we hypothesized that intensive care units whose practice, on average, was more consistent with the guidelines would have greater success in providing enteral nutrition.
Prospective observational study.
Fifty-nine intensive care units across Canada.
Consecutive cohort of mechanically ventilated patients.
In May 2003, participating intensive care units recorded nutrition support practices on a consecutive cohort of mechanically ventilated patients who stayed for a minimum of 72 hrs. Sites enrolled an average of 10.8 (range, 4-18) patients for a total of 638. Patients were observed for an average of 10.7 days.
We examined the association between five recommendations from the clinical practice guidelines most directly related to the provision of nutrition support (use of parenteral nutrition, feeding protocol, early enteral nutrition, small bowel feedings, and motility agents) and adequacy of enteral nutrition. We defined adequacy of enteral nutrition as the percent of prescribed calories that patients actually received. Across sites, the average adequacy of enteral nutrition over the observed stay in intensive care unit ranged from 1.8% to 76.6% (average 43.0%). Intensive care units with a greater than median utilization of parenteral nutrition (>17.5% patient days) had a much lower adequacy of enteral nutrition (32.9 vs. 52.7%, p 50% of their patients within the first 48 hrs had a higher adequacy of enteral nutrition than those that did not (48.1 vs. 34.4%, p 50% utilization of motility agents and/or any small bowel feedings in patients with high gastric residuals tended to have a higher adequacy of enteral nutrition than those intensive care units that did not (45.6 vs. 39.2%, p = .04, and 48.4 vs. 41.8%, p = .16, respectively).
Intensive care units that were more consistent with the Canadian clinical practice guidelines were more likely to successfully feed patients via enteral nutrition. Adoption of the Canadian clinical practice guidelines should lead to improved nutrition support practice in intensive care units. This may translate into better outcomes for critically ill patients receiving nutrition support.
Notes
Comment In: Crit Care Med. 2004 Nov;32(11):2354-515640660
PubMed ID
15640639 View in PubMed
Less detail