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Critical Care

Open Access

Energy deficit and hospital length of stay can be reduced by quality management of nutrition therapy: the ICU dietitian is essential

  • L Soguel1,
  • JP Revelly2,
  • C Longchamp2,
  • MD Schaller2 and
  • MM Berger2
Critical Care201115(Suppl 1):P376

Published: 1 March 2011


Energy DeficitNutrition TherapyGuideline ImplementationNutrition ProgramCumulate Energy


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.


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.


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.

Table 1


Period A: baseline

Period B: new protocol

Period C: protocol + dietitian

P value

Cumulated energy balance day 7

-5,870 ± 3,314

-5,307 ± 3,131

-3,946 ± 3,682*

< 0.001

Discharge energy balance

-6,972 ± 4,994

-5,996 ± 3,711*

-5,380 ± 4,998*


Energy delivery (kcal/kg/day)

14.8 ± 12.8

17.1 ± 12.7*

17.8 ± 12.6*

< 0.0001

* Significant post hoc difference.


A bottom-up protocol improved nutritional support. The ICU dietitian further improved the process (early introduction, feeding route), achieving better early energy balance.

Authors’ Affiliations

HES-SO, Geneva, Switzerland
CHUV, Lausanne, Switzerland


  1. 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.2005.03.006View ArticlePubMedGoogle Scholar
  2. 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. 10.1177/0115426507022004449View ArticlePubMedGoogle Scholar


© Soguel et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.