Department of Medicine, Queen's University, Kingston, ON, Canada.
JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34(6):707-15. doi: 10.1177/0148607110361901.
To develop, validate, and implement a system to reward top performers in critical care nutrition practice and to illuminate characteristics of top-performing intensive care units (ICUs).
An international, prospective, observational, cohort study conducted in May 2008.
179 ICUs from 18 countries.
2956 consecutively enrolled mechanically ventilated adult patients who stayed in the ICU for at least 72 hours.
To qualify for the "Best of the Best" (BOB) award, sites had to have implemented a nutrition protocol and contributed complete data on a minimum of 20 patients.
Data on nutrition practices were collected from ICU admission to ICU discharge for a maximum of 12 days. Eligible sites were ranked based on their performance on the following 5 criteria: adequacy of provision of energy, use of enteral nutrition (EN), early initiation of EN, use of promotility drugs and small bowel feeding tubes, and adequate glycemic control. Of the 179 participating ICUs, 81 qualified for the BOB award. Overall, the average nutrition adequacy across sites was 56.2% (site range, 20.3%-90.1%). The top 10 performers were identified and publicly recognized. Regression analysis suggested that the presence of a dietitian in the ICU was associated with a high BOB award ranking, whereas being located in the United States or China, relative to other participating countries, was associated with worst performance.
There is variable performance with respect to critical care nutrition practices across the world.
开发、验证和实施一项奖励重症监护营养实践中表现最佳者的系统，并阐明表现最佳的重症监护病房（ICU）的特点。
2008 年 5 月进行的一项国际性、前瞻性、观察性、队列研究。
来自 18 个国家的 179 个 ICU。
2956 名连续纳入的机械通气成年患者，这些患者在 ICU 至少停留 72 小时。
要获得“最佳中的最佳”（BOB）奖，机构必须实施营养方案，并至少对 20 名患者的完整数据做出贡献。
从 ICU 入院到 ICU 出院，最多 12 天内收集营养实践的数据。根据以下 5 项标准对合格机构进行排名：提供能量的充足性、使用肠内营养（EN）、早期开始 EN、使用促动力药物和小肠喂养管以及适当的血糖控制。在 179 个参与的 ICU 中，有 81 个符合 BOB 奖的资格。总体而言，各机构的平均营养充足率为 56.2%（机构范围为 20.3%-90.1%）。确定了前 10 名表现最佳者并公开表彰。回归分析表明，ICU 中存在营养师与获得高 BOB 奖排名相关，而与其他参与国家相比，位于美国或中国与最差表现相关。
全世界的重症监护营养实践表现存在差异。
