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  • Open Access

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

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  • 2,
  • 2,
  • 2 and
  • 2
Critical Care201115 (Suppl 1) :P376

  • Published:


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