Enteral nutrition in adult ICU patients: optimizing the outcome using computer-assisted individualisation of nutritional support

Background

The aim of this study is to develop a standardized procedure for assessing patients' nutritional needs and providing individualized enteral nutrition (EN) regimens by using a software tool that can accomplish this task in a fast, safe, yet simple way.

Methods

The study took place in the Surgical Intensive Care Unit of the University Surgical Department of Hippocration Hospital. The procedure involves input of patient data such as age, weight, and sex, along with data relevant to the clinical status of the patient, as well as treatment details. Specialized software can then analyze this data, determine nutritional parameters by implementing evidence-based equations, and calculate accurately an individual patient's daily nutritional needs in total energy, protein, hydrocarbons, fat, vitamins, minerals as well as the concentrations of each nutrient and total EN volume that will be administered on a 24-hour basis. The software was designed for monitoring the administered regimen and alarm in any case of mismatched calculation (according to the underlying disease, the clinical status and the nutritional parameters of the patient), and for informing the user about any metabolic complication that is likely to occur (according to the laboratory tests of the patient). For the purpose of this study, computer-calculated EN regimens were administered to 30 randomly selected patients in our unit and were then compared with the regimens, which would be administered without the help of the computer.

Results

There were large differences in EN calculated by the computer, while a number of times the computer designated the use of a different preparation in order to better suit the patient's nutritional needs. There was a reduction of the time consumed for the calculations (65%), and a decrease in false calculations (20%), whereas the early recognition of metabolic complications increased to 40%. The utilization of specialized software seemed to be able to help health professionals to select an optimal EN regimen and to estimate the appropriate fluid volume according to patient needs.

Conclusion

Implementation of this software enables health professionals to overcome the burden of calculations, while it can also accomplish labeling, statistic analysis, and record management, thus allowing the provision of individualized EN to become an efficient standard routine procedure. It promotes a simple, fast, and safe way of providing individualized nutritional support and the quality of nutritional services would certainly benefit from its routine clinical application.