Baydock Trisha, Bector Savita, Taylor Lorian M, Hansen Gregory
a Department of Nutrition and Food Services, Health Sciences Centre, Winnipeg, MB.
b Cummings School of Medicine, University of Calgary, Calgary, AB.
Can J Diet Pract Res. 2019 Mar 1;80(1):8-13. doi: 10.3148/cjdpr-2018-029. Epub 2018 Oct 3.
The purpose of this study was to determine the opinions and reported nutrition practices of Canadian Registered Dietitians (RDs) with regard to feeding patients with severe sepsis.
In 2017, surveys were sent to 112 eligible Canadian RDs in 10 provinces who were practicing in an intensive care environment. The survey included embedded branching logic questions developed to address major facets of sepsis, critical illness, and nutrition. The survey instrument assimilated all data in an anonymous manner, so respondents could not be linked to their answers.
Of the 64 RDs who responded (57% response rate), the majority practiced in adult intensive care (81%), within an academic center (59%), and in a mixed unit (73%). A wide variability of Canadian RDs' opinions and practice was reported in determining energy requirements, enteral nutrition (EN) practice, EN with vasoactive agents, parenteral nutrition (PN), and supplemental micronutrients.
Practice variability of Canadian RDs likely reflects gaps in both evidence and guidelines for severe sepsis. Further research efforts are needed to customize nutritional requirements in the patient with evolving sepsis, EN with patients at high risk for gastrointestinal dysfunction, optimizing PN, and the role of micronutrients.
本研究旨在确定加拿大注册营养师（RD）对于重症脓毒症患者喂养方面的意见及所报告的营养实践情况。
2017年，向加拿大10个省份在重症监护环境中执业的112名符合条件的注册营养师发送了调查问卷。该调查包含为解决脓毒症、危重病和营养等主要方面而设计的嵌入式分支逻辑问题。调查工具以匿名方式收集所有数据，因此无法将受访者与其答案关联起来。
在回复的64名注册营养师中（回复率为57%），大多数在成人重症监护病房工作（81%），在学术中心工作（59%），且在混合病房工作（73%）。在确定能量需求、肠内营养（EN）实践、使用血管活性药物时的肠内营养、肠外营养（PN）以及补充微量营养素方面，加拿大注册营养师的意见和实践存在很大差异。
加拿大注册营养师的实践差异可能反映出重症脓毒症在证据和指南方面的差距。需要进一步开展研究，以针对病情不断变化的脓毒症患者定制营养需求、针对胃肠道功能障碍高危患者的肠内营养、优化肠外营养以及确定微量营养素的作用。
