Attitudes and beliefs related to the Canadian critical care nutrition practice guidelines: an international survey of critical care physicians and dietitians.

BACKGROUND

The objective of this study was to evaluate the attitudes of critical care practitioners toward the Canadian Critical Care Nutrition Clinical Practice Guidelines (CPGs) and compare them with actual practice.

METHODS

An international Web-based survey was conducted. Respondents were asked to rate their strength of recommendation for 26 nutrition practices included in the Canadian CPGs. Attitudinal results were compared with actual practice on each recommendation.

RESULTS

514 practitioners from 27 countries completed the survey. The majority (91.4%) considered nutrition therapy to be very important for critically ill patients. There was strong endorsement for the following established practices: enteral nutrition (EN) used in preference to parenteral nutrition (PN), use of polymeric solutions and feeding protocols, and avoiding hyperglycemia. There was also strong endorsement for the following practices that are not routinely done in actual practice: EN initiated within 24 to 48 hours of admission, use of motility agents, head-of-bed elevation, use of glutamine and antioxidants, and maximizing EN before starting PN. There was diversity of opinion on the recommendations pertaining to arginine-supplemented diets, small bowel feeding, use of pharmaconutrients, intensive insulin therapy, and withholding soybean oil lipids in PN solutions and hypocaloric PN.

CONCLUSIONS

Overall, attitudes toward the Canadian CPGs were positive. However, we identified some areas where there was diversity of opinion, highlighting a need for further research and education. System tools may be a useful strategy to integrate guideline recommendations into practice where there is strong endorsement but the recommendation is not happening in actual practice.