1 Medical/Surgical Intensive Care Unit, Specialized Complex Care Program, St. Michael's Hospital, Toronto, Ontario, Canada.
2 Trauma/Neurosurgery Program, St. Michael's Hospital, Toronto, Ontario, Canada.
J Intensive Care Med. 2018 Mar;33(3):209-217. doi: 10.1177/0885066617749175. Epub 2017 Dec 28.
New comprehensive guidelines for nutrition support (NS) in the intensive care unit (ICU) can be used to improve quality of care and benchmark current practice. The objective of this study was to (a) compare NS practices in our medical/surgical ICU (MSICU) to 18 recommendations described in the Canadian Clinical Practice Guidelines and Society of Critical Care Medicine/American Society of Parenteral and Enteral Nutrition guidelines, (b) determine the percentage of goal calories and protein delivered, and (c) identify the barriers to successful NS delivery.
This was a prospective observation trial of up to 14 days duration.
A 24-bed MSICU in a tertiary teaching hospital in Toronto, Canada.
We studied 98 mechanically ventilated patients with any diagnosis who were expected to require either enteral nutrition (EN) or parenteral nutrition (PN) for >48 hours.
We measured nutritional intake, barriers to nutritional intake, and parameters that allowed comparison of our practice to 18 guidelines.
Mean delivery of protein and energy was 79.3% and 81.1% of goal, respectively. The average time to initiation of EN support was 29.5 ± 23.7 hours. The 3 main reasons for interruption to enteral feeding were airway management issues, procedures, and gastrointestinal intolerance. Enteral feeding during vasopressor therapy was well tolerated. Ten of the 18 guidelines were followed for ≥80% of the time. Protein goals for patients on renal replacement therapy and patients with liver disease were not reached. Head-of-bed positioning was also inadequate. The 13 patients requiring PN all had appropriate indications for this therapy, including gastrointestinal leaks, maldigestion, or malabsorption.
Nutrition support delivery was successful for most patients in this study. However, only 10 of the 18 guidelines were adequately followed. This study helped identify NS practices that work well and others that require strategies for improvement.
新的综合性营养支持（NS）指南可用于改善重症监护病房（ICU）的护理质量，并为当前实践提供基准。本研究的目的是：（a）将我们的内科/外科 ICU（MSICU）的 NS 实践与加拿大临床实践指南和危重病医学会/美国肠外和肠内营养学会指南中的 18 条建议进行比较，（b）确定目标热量和蛋白质的输送百分比，以及（c）确定成功实施 NS 输送的障碍。
这是一项为期最多 14 天的前瞻性观察试验。
加拿大多伦多一家三级教学医院的 24 张床位的 MSICU。
我们研究了 98 例患有任何诊断的机械通气患者，预计需要肠内营养（EN）或肠外营养（PN）超过 48 小时。
我们测量了营养摄入、营养摄入障碍以及允许将我们的实践与 18 条指南进行比较的参数。
蛋白质和能量的平均输送量分别为目标的 79.3%和 81.1%。EN 支持的平均启动时间为 29.5±23.7 小时。中断肠内喂养的 3 个主要原因是气道管理问题、程序和胃肠道不耐受。血管加压治疗期间耐受肠内喂养。18 条指南中有 10 条在≥80%的时间内得到遵守。接受肾脏替代治疗的患者和肝病患者的蛋白质目标未达到。床头抬高的体位也不足。所有需要 PN 的 13 例患者均有适当的指征，包括胃肠道漏出、消化不良或吸收不良。
本研究中大多数患者的营养支持治疗都取得了成功。然而，只有 10 条指南得到了充分遵守。这项研究有助于确定效果良好的 NS 实践和需要改进策略的其他实践。
