Nutrition of the critically ill patient and effects of implementing a nutritional support algorithm in ICU.
OBJECTIVE
To test whether a feeding algorithm could improve the nutritional support of intensive care patients.


BACKGROUND
Numerous factors may impede delivery of both enteral and parenteral nutrition to patients in the intensive care unit. Often there is a discrepancy between what is prescribed and actual delivery of nutrients. The purpose of this study was to test the effect of a nutritional support algorithm in an intensive care unit mainly by using the enteral route and if necessary by combining enteral and parenteral nutrition.


METHODS
In this prospective study, nutritional data were collected from routinely fed critically ill patients (controls, n=21) during the first three days following admission to the intensive care unit. A nutritional support algorithm was then implemented and nutritional data were collected from critically ill patients who participated in this intervention (intervention group, n=21). Data collected included the total amount of calories prescribed vs. received, onset of delivery of enteral nutrition, enteral vs. parenteral nutrition, and the use and size of enteral feeding tubes.


RESULTS
Patients in the intervention group were both prescribed and actually received significantly larger amounts of nutrients than patients in the control group. They also received a larger proportion of their nutrients in the form of enteral nutrition. In addition, the nutritional support algorithm led to greater consistency in nursing practices with respect to aspiration of gastric content and rate of increment in enteral feeding.


CONCLUSIONS
The study confirms that a nutritional support algorithm improved the delivery of nutrients to critically ill patients. The algorithm was most effective with respect to the delivery of enteral nutrition. The effect was primarily because of early and more rapid increment in the delivery of enteral nutrition administered by nurses based on improved physician orders. The combination of enteral and parenteral nutrition may contribute to meeting adequate nutritional requirements.


CONCLUSIONS
By using a nutritional algorithm focused on enteral nutrition, but including parenteral nutrition as a supplement, it is possible to improve the delivery of clinical nutrition in the intensive care unit patients.
Wøien
Hilde
H
Department of Anaesthesia, Rikshospitalet-Radiumhospitalet HF National Hospital, Oslo, Norway. hilde.woien@rikshospitalet.no
Bjørk
Ida Torunn
IT
D000465:Algorithms; D015400:Clinical Nursing Research; D002985:Clinical Protocols / Q000592:standards; D003422:Critical Care / Q000379:methods* / Q000592:standards; D016638:Critical Illness / Q000628:therapy; D003663:Decision Trees; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods* / Q000451:nursing / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D009730:Nursing Assessment; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods* / Q000451:nursing / Q000592:standards; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D013997:Time Factors