由专业营养支持团队开展的人体测量培训项目可改善危重症患儿的营养状况评估。

A training program for anthropometric measurements by a dedicated nutrition support team improves nutritional status assessment of the critically ill child.

作者信息

Valla Frederic V, Ford-Chessel Carole, Meyer Rosan, Berthiller Julien, Dupenloup Christine, Follin-Arbelet Nathalie, Hubert Anna, Javouhey Etienne, Peretti Noel

机构信息

1Pediatric Intensive Care, Pediatric Department, Réanimation Pédiatrique, Hôpital Femme-Mère-Enfant, Lyon-Bron, France. 2Service diététique, Nutrition Department, Hôpital Femme-Mère-Enfant, Groupe Hospitalier Est, Lyon, France. 3Department of Paediatrics, Imperial College London, London, United Kingdom. 4Pôle Information Médicale Evaluation Recherche, Equipe d'Accueil 4129, Hospices Civils de Lyon et Université de Lyon, Lyon, France. 5Inserm, CIC201, EPICIME, RIPPS, CNRS UMR 5558 France. 6CHU Lyon, Hop L. Pradel, Service de Pharmacologie Clinique, Université Lyon, Lyon, France. 7Hépatologie Gastroentérologie et Nutrition Pédiatrique, Pediatric Department, Hôpital Femme-Mère-Enfant, Lyon-Bron, France.

出版信息

Pediatr Crit Care Med. 2015 Mar;16(3):e82-8. doi: 10.1097/PCC.0000000000000363.

DOI:10.1097/PCC.0000000000000363

PMID:25607742

Abstract

OBJECTIVES

The cornerstone of an optimal nutrition approach in PICUs is to evaluate the nutritional status of any patient. Anthropometric measurements and nutritional indices calculation allow for nutritional status assessment, which is not often part of routine management, as it is considered difficult to perform in this setting. We designed a study to evaluate the impact of a training program by the PICU nutritional support team on the implementation of routine anthropometric measurements on our PICU.

DESIGN

A prospective study was performed over a 2-year period, which included: a baseline evaluation of nutritional assessment, knowledge, anthropometric measurements (weight, height, and head and mid upper arm circumferences), and nutritional indices calculation in patient files. This was followed by a training program to implement the newly developed nutrition assessment guidelines, which included anthropometrical measurements and also the interpretation of these. The impact of this nutritional assessment program was reviewed annually for 2 years after the implementation.

SETTING

PICU--Lyon, France.

PATIENTS AND SUBJECTS

PICU nursing and medical staff, and patients admitted in February 2011, 2012, and 2013.

INTERVENTIONS

Training program.

MEASUREMENTS AND MAIN RESULTS

Ninety-nine percent of staff (n = 145) attended the individual teaching. We found significant progress in nutritional awareness and confidence about nutritional assessment following the teaching program. In addition, an improvement in staff knowledge about undernutrition and its consequences were found. We enrolled 41, 55, and 91 patients in 2011, 2012, and 2013, respectively. There was a significant increase in anthropometric measurements during this time: 32%, 65% (p = 0.002), and 96% in 2013 (p < 0.001). Nutritional indices were calculated in 20%, 74% (p < 0.001), and 96% (p < 0.001) of cases.

CONCLUSIONS

This is the first study, showing that a targeted nutritional assessment teaching program that highlights both the importance and techniques of anthropometrical measurements has successfully been implemented in a PICU. It managed to improve staff knowledge and nutritional practice.

摘要

目的

儿科重症监护病房（PICU）最佳营养方法的基石是评估任何患者的营养状况。人体测量和营养指标计算有助于进行营养状况评估，但这通常并非常规管理的一部分，因为在这种情况下被认为难以实施。我们设计了一项研究，以评估PICU营养支持团队的培训计划对我们PICU常规人体测量实施情况的影响。

设计

进行了一项为期2年的前瞻性研究，包括：对营养评估、知识、人体测量（体重、身高、头围和上臂中部周长）以及患者档案中的营养指标计算进行基线评估。随后开展一项培训计划，以实施新制定的营养评估指南，其中包括人体测量及其解读。在实施后的2年里，每年对该营养评估计划的影响进行评估。

地点

法国里昂的PICU。

患者和研究对象

PICU护理和医务人员，以及2011年、2012年和2013年2月收治的患者。

干预措施

培训计划。

测量指标和主要结果

99%的工作人员（n = 145）参加了个人教学。我们发现，教学计划实施后，工作人员在营养意识和营养评估信心方面取得了显著进步。此外，工作人员对营养不良及其后果的知识也有所提高。2011年、2012年和2013年分别纳入了41例、55例和91例患者。在此期间，人体测量有显著增加：2013年分别为32%、65%（p = 0.002）和96%（p < 0.001）。分别有20%、74%（p < 0.001）和96%（p < 0.001）的病例计算了营养指标。