Intensive Care Unit (ICU), Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China (mainland).
Intensive Care Unit (ICU), Taipei Medical University Ningbo Medical Center, Ningbo, Zhejiang, China (mainland).
Med Sci Monit. 2019 Nov 16;25:8645-8650. doi: 10.12659/MSM.917684.
BACKGROUND The use of evidence-based clinical practice guidelines improves the quality of patient medical care. Although the implementation of clinical guidelines can be a challenge, nutritional support is important for critically ill patients. This prospective observational study aimed to investigate the attention to and implementation of guidelines for nutritional support in an Intensive Care Unit (ICU) in China and to identify factors that determine attention to these guidelines. MATERIAL AND METHODS The study included 16 medical residents who were interviewed while working in an emergency Intensive Care Unit (ICU) during one month. A structured interview questionnaire on attention to patient nutritional guidelines was used. Interviews were conducted daily after an early ICU ward round, and residents were asked questions regarding each patient. RESULTS The response rate from medical residents was 99.6% (455/457). The rate of attention to and implementation of nutritional support guidelines was 57.1% (260/455) and 73.1% (334/457), respectively. Multivariate logistic regression analysis showed that weekdays and weekends (OR, 0.59; 95% CI, 0.38-0.91), medical groups (OR, 0.67; 95% CI, 0.46-0.98), and the numbers of patients admitted (OR, 0.91; 95% CI, 0.85-0.97) were independently associated with attention to nutritional support guidelines by the residents. CONCLUSIONS Nutritional guidelines for patients in the ICU were not fully paid attention to by medical residents or implemented. The reasons included high work demands and lack of standardized training. Further studies are needed to determine whether measures to reduce workload and improve medical training can improve adherence to nutritional support guidelines in the ICU.
循证临床实践指南的使用可以提高患者医疗质量。尽管临床指南的实施可能具有挑战性，但营养支持对危重症患者至关重要。本前瞻性观察研究旨在调查中国 ICU 中对营养支持指南的关注和实施情况，并确定决定对这些指南关注的因素。
研究纳入了 16 名在一个月期间在急诊 ICU 工作的住院医师，对其进行了关于关注患者营养指南的结构化访谈问卷调查。每天在早期 ICU 查房后进行访谈，要求住院医师对每位患者提出问题。
住院医师的应答率为 99.6%（455/457）。对营养支持指南的关注和实施率分别为 57.1%（260/455）和 73.1%（334/457）。多变量 logistic 回归分析显示，工作日和周末（OR，0.59；95%CI，0.38-0.91）、医疗组（OR，0.67；95%CI，0.46-0.98）和入院患者人数（OR，0.91；95%CI，0.85-0.97）与住院医师对营养支持指南的关注独立相关。
住院医师对 ICU 患者的营养指南没有给予充分关注或实施。原因包括工作量大且缺乏标准化培训。需要进一步研究，以确定是否可以采取减轻工作量和改善医疗培训的措施，从而提高 ICU 中对营养支持指南的依从性。
