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

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.

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

  1. 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.2005.03.006

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    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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Correspondence to L Soguel.

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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, P376 (2011). https://doi.org/10.1186/cc9796

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Keywords

  • Energy Deficit
  • Nutrition Therapy
  • Guideline Implementation
  • Nutrition Program
  • Cumulate Energy