Serviá Goixart Luis, López Delgado Juan Carlos, Grau Carmona Teodoro
Hospital Arnau de Vilanova.
Hospital Universitari de Bellvitge.
Nutr Hosp. 2019 Jul 1;36(3):510-516. doi: 10.20960/nh.02323.
Background: the application of specialized nutritional support (SNE) is difficult at the organizational level due to the complexity of clinical practice guidelines and we do not know the degree of adherence to the published nutritional recommendations. The aim of this study was to assess the degree of adherence to the recommendations of high impact and "do not do" within our environment, in order to show areas for improvement. Methods: survey of nine questions agreed by experts and carried out in different ICUs of our environment, which reflected the recommendations in SNE. Data related to the organizational characteristics and the healthcare provider that indicated the nutritional support were collected. The differences regarding the degree of adherence between the level of care and the presence of an expert in these units were analyzed. Results: thirty-seven ICUs participated, which corresponded mostly to second level hospitals and polyvalent ICUs with an SNE indicated by intensivists. The adherence to the recommendations was > 80%, with three exceptions associated with issues related to the refeeding syndrome (70.3%), the caloric-protein adjustment of nutrition according to the patient's evolutionary phase (51.4%) and the adjustment of protein intake in patients with renal failure (40.5%). There were no differences according to the level of care or the presence of an expert in these ICUs. Only a greater availability of local nutrition protocols was observed in those ICUs with an expertise. Conclusions: there is a high theoretical adherence to the majority of recommendations in the nutritional field, with exceptions that could correspond to areas where there is an opportunity for improvement.
由于临床实践指南的复杂性，在组织层面应用专业营养支持（SNE）存在困难，而且我们不清楚对已发布营养建议的遵循程度。本研究的目的是评估在我们的环境中对高影响力建议和“不做”建议的遵循程度，以展示改进领域。方法：对专家认可的九个问题进行调查，并在我们环境中的不同重症监护病房（ICU）开展，这些问题反映了SNE中的建议。收集与组织特征以及表明提供营养支持的医疗服务提供者相关的数据。分析了护理级别和这些科室中专家的存在情况在遵循程度方面的差异。结果：37个ICU参与了调查，这些ICU大多对应二级医院和多学科ICU，营养支持由重症监护医生提供。对建议的遵循率>80%，有三个例外情况与再喂养综合征（70.3%）、根据患者病程阶段调整营养的热量 - 蛋白质比例（51.4%）以及肾衰竭患者蛋白质摄入量调整（40.5%）相关问题有关。在这些ICU中，根据护理级别或专家的存在情况没有差异。仅在有专业知识的ICU中观察到当地营养方案的可用性更高。结论：在营养领域，对大多数建议有较高的理论遵循度，但存在一些例外情况，这些情况可能对应有改进机会的领域。
