Bordejé María Luisa, Juan Díaz Mar, Crespo Mónica, Ferreruela Mireia, Solano Esther
Servicio de Medicina Intensiva. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona.
Unidad de Medicina Intensiva. Hospital Clínic Universitari de València.
Nutr Hosp. 2021 Jun 10;38(3):436-445. doi: 10.20960/nh.03415.
Introduction: optimal nutrition in the critically ill patient is a key aspect for recovery. Objectives: to promote training in and knowledge of mixed nutrition support (MNS) by means of a clinical algorithm among intensivists for improving the nutritional status of critically ill patients. Methods: a before-and-after study with the participation of 19 polyvalent intensive care units (ICUs) in 10 autonomous communities. Five members of the scientific committee trained the trainers by means of oral presentations and a clinical algorithm on MNS. Then, trainers were responsible for explaining the algorithm to local intensivists in their ICUs. The 30-item study questionnaire was completed before and after the intervention by 179 and 105 intensivists, respectively. Results: a clear improvement of knowledge was found in six (20 %) specific MNS-related questions. In 11 items (36.6 %), adequate knowledge on different aspects of nutritional support that were already present before the intervention were maintained, and in five items (16.7 %) an improvement in the rate of correct responses was recorded. There were no improvements in correct responses for four items (13.3 %), and for four (13.3 %) additional items the percentage of correct responses decreased. Conclusions: the use of the MNS algorithm has achieved a solid consolidation of the main concepts of MNS. Some aspects regarding how to manage the malnourished patient, how to identify them and what type of nutrition to guide from the beginning of admission to the ICU, nutritional contributions in special situations, and the monitoring of possible complications such as refeeding are areas for which further training strategies are needed.
危重症患者的最佳营养是康复的关键因素。目的：通过临床算法促进重症监护医生对混合营养支持（MNS）的培训并提高其相关知识，以改善危重症患者的营养状况。方法：一项前后对照研究，有来自10个自治区的19个综合重症监护病房（ICU）参与。科学委员会的五名成员通过口头报告和关于MNS的临床算法对培训人员进行培训。然后，培训人员负责向其所在ICU的当地重症监护医生解释该算法。179名和105名重症监护医生分别在干预前后完成了这份包含30个条目的研究问卷。结果：在六个（20%）与MNS相关的特定问题上，知识水平有明显提高。在11个条目（36.6%）中，干预前就已具备的关于营养支持不同方面的充分知识得以保持，在五个条目（16.7%）中，正确回答率有所提高。有四个条目（13.3%）的正确回答没有改善，另外四个条目（13.3%）的正确回答百分比下降。结论：MNS算法的使用已使MNS的主要概念得到了稳固强化。在如何管理营养不良患者、如何识别他们以及从入住ICU开始就应指导何种营养类型、特殊情况下的营养供给以及对诸如再喂养等可能并发症的监测等方面，还需要进一步的培训策略。
